Provider Demographics
NPI:1710192356
Name:HERMAN, MINDY S (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:S
Last Name:HERMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W CARVER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3303
Mailing Address - Country:US
Mailing Address - Phone:631-673-4600
Mailing Address - Fax:631-673-6401
Practice Address - Street 1:200 W CARVER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3303
Practice Address - Country:US
Practice Address - Phone:631-673-4600
Practice Address - Fax:631-673-6401
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015627225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist