Provider Demographics
NPI:1477566735
Name:HERZBERG, ABRAHAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:HERZBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2107
Mailing Address - Country:US
Mailing Address - Phone:516-561-1617
Mailing Address - Fax:516-740-0782
Practice Address - Street 1:300 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2107
Practice Address - Country:US
Practice Address - Phone:516-561-1617
Practice Address - Fax:576-740-0782
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003188213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31906Medicare UPIN
P3392Medicare ID - Type Unspecified