Provider Demographics
NPI: | 1821016692 |
---|---|
Name: | DOCS PHYSICIANS AFFILIATED WITH BIMC |
Entity Type: | Organization |
Organization Name: | DOCS PHYSICIANS AFFILIATED WITH BIMC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HERZOG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 914-749-6801 |
Mailing Address - Street 1: | 465 COLUMBUS AVE |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | VALHALLA |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10595-1336 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 914-749-6846 |
Mailing Address - Fax: | 914-769-1824 |
Practice Address - Street 1: | 55 E 34TH ST |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10016-4337 |
Practice Address - Country: | US |
Practice Address - Phone: | 914-749-6846 |
Practice Address - Fax: | 914-769-1824 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-18 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
Not Answered | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
Not Answered | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
Not Answered | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
Not Answered | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | Group - Multi-Specialty |
Not Answered | 207UN0902X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Imaging & Therapy | Group - Multi-Specialty |
Not Answered | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
Not Answered | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
Not Answered | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
Not Answered | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
Not Answered | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
Not Answered | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
Not Answered | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
Not Answered | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
Not Answered | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | W32642 | Medicare ID - Type Unspecified | |
NY | W32641 | Medicare ID - Type Unspecified |