Provider Demographics
NPI:1295890986
Name:FLAX, HERSCHEL (MD)
Entity type:Individual
Prefix:DR
First Name:HERSCHEL
Middle Name:
Last Name:FLAX
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 1:28 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1707
Mailing Address - Country:US
Mailing Address - Phone:516-487-3185
Mailing Address - Fax:516-487-8760
Practice Address - Street 1:9 E 63RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7236
Practice Address - Country:US
Practice Address - Phone:212-755-3833
Practice Address - Fax:212-832-9279
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124389208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA68102Medicare UPIN
NY966931Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER