Provider Demographics
NPI:1699041939
Name:JEFFREY HERZLICH DC PC
Entity Type:Organization
Organization Name:JEFFREY HERZLICH DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZLICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-805-1010
Mailing Address - Street 1:8437 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1643
Mailing Address - Country:US
Mailing Address - Phone:718-805-1010
Mailing Address - Fax:718-805-1038
Practice Address - Street 1:8437 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1643
Practice Address - Country:US
Practice Address - Phone:718-805-1010
Practice Address - Fax:718-805-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60755Medicare UPIN