Provider Demographics
NPI:1447227228
Name:HERBOWY, MICHAEL TARAS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TARAS
Last Name:HERBOWY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 W RIDGE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2724
Mailing Address - Country:US
Mailing Address - Phone:585-227-4560
Mailing Address - Fax:585-227-4608
Practice Address - Street 1:2081 W RIDGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2724
Practice Address - Country:US
Practice Address - Phone:585-227-4560
Practice Address - Fax:585-227-4608
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H69517Medicare UPIN
NYDD2244Medicare ID - Type Unspecified