Provider Demographics
NPI:1255196549
Name:HERZIG, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:HERZIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:YOSEF
Other - Middle Name:
Other - Last Name:HERZIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13518 77TH AVE APT A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2800
Mailing Address - Country:US
Mailing Address - Phone:732-675-0554
Mailing Address - Fax:
Practice Address - Street 1:1634 E 31ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4211
Practice Address - Country:US
Practice Address - Phone:732-675-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1215391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical