Provider Demographics
NPI:1790862902
Name:HERTZ, JOSEF H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEF
Middle Name:H
Last Name:HERTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEF
Other - Middle Name:H
Other - Last Name:HERTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:330 MAYFAIR DR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6716
Mailing Address - Country:US
Mailing Address - Phone:718-221-1111
Mailing Address - Fax:718-221-0714
Practice Address - Street 1:700 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2230
Practice Address - Country:US
Practice Address - Phone:718-221-1111
Practice Address - Fax:718-221-0714
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00460288Medicaid
19A491Medicare PIN
C06521Medicare UPIN