Provider Demographics
NPI:1184624157
Name:HERZBERG, GILBERT Z (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:Z
Last Name:HERZBERG
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 1:745 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4745
Mailing Address - Country:US
Mailing Address - Phone:203-655-6000
Mailing Address - Fax:203-655-2003
Practice Address - Street 1:745 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4745
Practice Address - Country:US
Practice Address - Phone:203-655-6000
Practice Address - Fax:203-655-2003
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT324082080P0202X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420759Medicaid
NY59H84EA202Medicare PIN
NY59H84EA201Medicare PIN