Provider Demographics
NPI:1942350780
Name:HERTZ, HOWARD M
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:M
Last Name:HERTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3417
Mailing Address - Country:US
Mailing Address - Phone:631-661-2277
Mailing Address - Fax:631-669-2190
Practice Address - Street 1:350 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3417
Practice Address - Country:US
Practice Address - Phone:631-661-2277
Practice Address - Fax:631-669-2190
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144433207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00800019Medicaid
NY00800019Medicaid
NY93A641Medicare ID - Type Unspecified