Provider Demographics
NPI:1467466607
Name:HERMAN, JAY H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:H
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:132 S. 10TH STREET
Mailing Address - Street 2:SUITE 285K
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5244
Mailing Address - Country:US
Mailing Address - Phone:215-503-5642
Mailing Address - Fax:215-503-4817
Practice Address - Street 1:132 S. 10TH STREET
Practice Address - Street 2:SUITE 285K
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5244
Practice Address - Country:US
Practice Address - Phone:215-503-5642
Practice Address - Fax:215-503-4817
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035898E207ZB0001X, 207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001269752Medicaid
NJ5444209Medicaid
NJ5444209Medicaid