Provider Demographics
NPI:1659670693
Name:HERRERA-ROJAS, MARTHA L (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:L
Last Name:HERRERA-ROJAS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4567
Mailing Address - Country:US
Mailing Address - Phone:973-204-6456
Mailing Address - Fax:
Practice Address - Street 1:1381 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4101
Practice Address - Country:US
Practice Address - Phone:718-892-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant