Provider Demographics
NPI:1154787901
Name:HERZKA, ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HERZKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELISHEVA
Other - Middle Name:
Other - Last Name:GROHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 ELYISE RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1413
Mailing Address - Country:US
Mailing Address - Phone:845-825-3466
Mailing Address - Fax:
Practice Address - Street 1:7 ELYISE RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1413
Practice Address - Country:US
Practice Address - Phone:845-825-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-10
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659322163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse