Provider Demographics
NPI:1497772206
Name:HERSHENBERG, BERNARD (PHD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:HERSHENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 ROUTE 70 E
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2037
Mailing Address - Country:US
Mailing Address - Phone:856-424-7272
Mailing Address - Fax:856-424-6977
Practice Address - Street 1:1874 ROUTE 70 E
Practice Address - Street 2:SUITE 4
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2037
Practice Address - Country:US
Practice Address - Phone:856-424-7272
Practice Address - Fax:856-424-6977
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100111600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ191237AQYMedicare PIN