Provider Demographics
NPI:1265620066
Name:PERRY B HERSON MD PC
Entity type:Organization
Organization Name:PERRY B HERSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ-VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:516-746-0772
Mailing Address - Street 1:99 HILLSIDE AVE
Mailing Address - Street 2:SUITE 99F
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2333
Mailing Address - Country:US
Mailing Address - Phone:516-746-0772
Mailing Address - Fax:516-746-0310
Practice Address - Street 1:99 HILLSIDE AVE
Practice Address - Street 2:SUITE 99F
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2333
Practice Address - Country:US
Practice Address - Phone:516-746-0772
Practice Address - Fax:516-746-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYHOO616Medicare UPIN