Provider Demographics
NPI:1477533420
Name:HERZBERG, ZIPORA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ZIPORA
Middle Name:
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WESTOVER PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1730
Mailing Address - Country:US
Mailing Address - Phone:516-239-6770
Mailing Address - Fax:516-239-6770
Practice Address - Street 1:30 WESTOVER PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1730
Practice Address - Country:US
Practice Address - Phone:516-239-6770
Practice Address - Fax:516-239-6770
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8589103G00000X, 103T00000X, 103TA0700X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X, 103TH0100X, 103TM1800X, 103TR0400X, 103TS0200X
NY85889103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01584803Medicaid
NYV40721Medicare ID - Type Unspecified
NY01584803Medicaid