Provider Demographics
NPI:1558431304
Name:HERSKOWITZ, JULIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:
Last Name:HERSKOWITZ
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 1:755 PARK AVE
Mailing Address - Street 2:SUITE # 140
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3972
Mailing Address - Country:US
Mailing Address - Phone:631-549-8867
Mailing Address - Fax:631-423-8446
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:SUITE # 140
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3972
Practice Address - Country:US
Practice Address - Phone:631-549-8867
Practice Address - Fax:631-423-8446
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
NY006644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1811263429OtherMEDICARE NPI
NYA100066565OtherMEDICARE P-TAN
NY113111686OtherEIN TAX ID