Provider Demographics
NPI:1336157197
Name:PAUL D HIERHOLZER DO PC
Entity Type:Organization
Organization Name:PAUL D HIERHOLZER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HIERHOLZER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-653-2101
Mailing Address - Street 1:750 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2363
Mailing Address - Country:US
Mailing Address - Phone:609-653-2101
Mailing Address - Fax:
Practice Address - Street 1:750 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2363
Practice Address - Country:US
Practice Address - Phone:609-653-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB059402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110180785OtherRAILROAD MEDICARE
NJ0080947001OtherKEYSTONE
NJ0080947001OtherAMERIHEALTH
NJ374375OtherPABS (GROUP)
NJ1078435OtherHORIZON MERCY
NJ16846OtherUNIVERSITY HEALTH PLANS
NJ374375OtherKEYSTONE
NJ5565804Medicaid
NJ=========OtherAETNA
NJ16846OtherUNIVERSITY HEALTH PLANS
NJ=========OtherAMERICHOICE
NJ5565804Medicaid
NJ374375OtherKEYSTONE
NJ=========OtherGHI GROUP HEALTH
NJ=========OtherUNITED HEALTHCARE
NJ0080947001OtherKEYSTONE
NJ=========OtherTRICARE/CHAMPUS
NJ=========OtherCIGNA
NJ=========OtherGHI GROUP HEALTH
NJ=========OtherAETNA