Provider Demographics
NPI:1912014010
Name:HERMAN, EUGENE GEORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:GEORGE
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 N CENTRE AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3923
Mailing Address - Country:US
Mailing Address - Phone:516-766-3330
Mailing Address - Fax:516-766-3563
Practice Address - Street 1:77 N CENTRE AVE
Practice Address - Street 2:STE 303
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3923
Practice Address - Country:US
Practice Address - Phone:516-766-3330
Practice Address - Fax:516-766-3563
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032691-1204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY130740146OtherADA
NY00304765Medicaid
NY00304765Medicaid
T49914Medicare UPIN