Provider Demographics
NPI:1639515273
Name:HERSCHBERG, SHOSHANA
Entity Type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:HERSCHBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANI
Other - Middle Name:
Other - Last Name:ADLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 BEDELL TER
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2445
Mailing Address - Country:US
Mailing Address - Phone:516-481-9309
Mailing Address - Fax:
Practice Address - Street 1:230 BEDELL TER
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2445
Practice Address - Country:US
Practice Address - Phone:516-481-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY838126981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist