Provider Demographics
NPI:1568999886
Name:THOMAS M HERSKOVIC MD PA
Entity Type:Organization
Organization Name:THOMAS M HERSKOVIC MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERSKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-625-3366
Mailing Address - Street 1:98 FORD RD STE 3H
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1356
Mailing Address - Country:US
Mailing Address - Phone:973-625-3366
Mailing Address - Fax:973-625-0349
Practice Address - Street 1:703 MAIN ST DEPT OF
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2683
Practice Address - Fax:973-754-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA037836002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty