Provider Demographics
NPI:1457446643
Name:HERRERA, IRIS C (MD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:C
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30 BERGEN ST
Mailing Address - Street 2:ADMC 12 1205
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3000
Mailing Address - Country:US
Mailing Address - Phone:973-972-0037
Mailing Address - Fax:973-972-9355
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:SUITE 4400
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-1438
Practice Address - Fax:973-972-6651
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07666600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0067652Medicaid
NJH01361Medicare UPIN
NJ089158Medicare ID - Type Unspecified