Provider Demographics
NPI:1902841091
Name:DR. MICHAEL HERSHORN, P.A.
Entity Type:Organization
Organization Name:DR. MICHAEL HERSHORN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-614-2326
Mailing Address - Street 1:PO BOX 9318
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33075-9318
Mailing Address - Country:US
Mailing Address - Phone:954-614-2326
Mailing Address - Fax:954-722-6447
Practice Address - Street 1:8333 W MCNAB RD
Practice Address - Street 2:SUITE 131
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3242
Practice Address - Country:US
Practice Address - Phone:954-614-2326
Practice Address - Fax:954-722-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588655864Medicare ID - Type Unspecified
FL75879Medicare ID - Type Unspecified