Provider Demographics
NPI:1558705483
Name:HERRERA, STEVEN J (LPN)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:HERRERA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11B GORES DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2007
Mailing Address - Country:US
Mailing Address - Phone:631-295-6424
Mailing Address - Fax:
Practice Address - Street 1:11B GORES DR
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2007
Practice Address - Country:US
Practice Address - Phone:631-295-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308461-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse