Provider Demographics
NPI:1821166158
Name:HERTZ, STANLEY MELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:MELVIN
Last Name:HERTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FERN DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2201
Mailing Address - Country:US
Mailing Address - Phone:516-484-6366
Mailing Address - Fax:516-484-2864
Practice Address - Street 1:55 FERN DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576
Practice Address - Country:US
Practice Address - Phone:516-484-6366
Practice Address - Fax:516-484-2864
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1274072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry