Provider Demographics
NPI:1467415851
Name:HIERHOLZER, PAUL DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DANIEL
Last Name:HIERHOLZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2778 DUNE DR
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:NJ
Mailing Address - Zip Code:08202-1978
Mailing Address - Country:US
Mailing Address - Phone:609-967-4070
Mailing Address - Fax:609-967-4115
Practice Address - Street 1:2778 DUNE DR
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:NJ
Practice Address - Zip Code:08202-1978
Practice Address - Country:US
Practice Address - Phone:609-967-4070
Practice Address - Fax:609-967-4115
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB059402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5565804OtherAMERIGROUP
NJ9615901OtherGHI GROUP HEALTH
NJ0453790OtherUS HEALTHCARE
NJ374375OtherKEYSTONE
NJ035900OtherPABS
NJ16846OtherUNIVERSITY HEALTH PLANS
NJ06600510000OtherAMERIHEALTH
NJ5565804Medicaid
NJ91000047000OtherAMERICHOICE
NJ06600510000OtherKEYSTONE
NJ1078435OtherHORIZON MERCY
NJ1078435OtherHORIZON MERCY
NJ5565804Medicaid