Provider Demographics
NPI:1609090216
Name:HERMAN, ANDREW EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:EDWARD
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 559
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030
Mailing Address - Country:US
Mailing Address - Phone:856-742-0584
Mailing Address - Fax:856-456-1402
Practice Address - Street 1:357 GREENWOOD AT MARKET
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030
Practice Address - Country:US
Practice Address - Phone:856-742-0584
Practice Address - Fax:856-456-1402
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3042308Medicaid
135161BA2Medicare UPIN
NJ3042308Medicaid