Provider Demographics
NPI:1598757247
Name:HERTZ, ROBERT MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARC
Last Name:HERTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-2213
Mailing Address - Country:US
Mailing Address - Phone:518-435-9931
Mailing Address - Fax:518-459-3715
Practice Address - Street 1:500 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2213
Practice Address - Country:US
Practice Address - Phone:518-435-9931
Practice Address - Fax:518-459-3715
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156115-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990981Medicaid
NY01990981Medicaid
NYE41759Medicare UPIN