Provider Demographics
NPI:1750473104
Name:HERRERA, CLARITA E (MD)
Entity Type:Individual
Prefix:
First Name:CLARITA
Middle Name:E
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 EAST 76TH ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-988-7680
Mailing Address - Fax:212-517-6582
Practice Address - Street 1:122 EAST 76TH ST
Practice Address - Street 2:STE 1A
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-988-7680
Practice Address - Fax:212-517-6582
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100699207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B19100Medicare UPIN
73A891Medicare ID - Type Unspecified