Provider Demographics
NPI:1396811725
Name:HERSON, PERRY B (MD)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:B
Last Name:HERSON
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 1:99 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201461-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH00616Medicare UPIN