Provider Demographics
NPI:1639127897
Name:HERSKOVITS, ARIE (MD)
Entity Type:Individual
Prefix:
First Name:ARIE
Middle Name:
Last Name:HERSKOVITS
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 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-2508
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1000
Practice Address - Fax:617-421-6084
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA596262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0034541OtherNEIGHBORHOOD HEALTH
MDJ14418OtherBLUE CROSS BLUE SHIELD
MA762051OtherTUFTS HEALTH PLAN
MDAA26055OtherHARVARD PILGRIM
MA0456295OtherCIGNA
MA3120147Medicaid
MA0456295OtherHEALTHSOURCE
MA0456295OtherHEALTHSOURCE
MDJ14418OtherBLUE CROSS BLUE SHIELD