Provider Demographics
NPI:1457451551
Name:HERBERT, JOSHUA BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BRYAN
Last Name:HERBERT
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 1:5 HIGH RIDGE PARK
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1332
Mailing Address - Country:US
Mailing Address - Phone:203-276-4644
Mailing Address - Fax:203-276-4090
Practice Address - Street 1:5 HIGH RIDGE PARK
Practice Address - Street 2:SUITE 103
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1332
Practice Address - Country:US
Practice Address - Phone:203-276-4644
Practice Address - Fax:203-276-4090
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H30199Medicare UPIN
H30199Medicare UPIN