Provider Demographics
NPI:1669576187
Name:HERRING, GARY STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEVEN
Last Name:HERRING
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 1:131 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1054
Mailing Address - Country:US
Mailing Address - Phone:201-664-3612
Mailing Address - Fax:201-722-3560
Practice Address - Street 1:131 CRAIG RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-1054
Practice Address - Country:US
Practice Address - Phone:201-664-3612
Practice Address - Fax:201-722-3560
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55527207Q00000X
NY209625-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F38179Medicare UPIN
71V001Medicare ID - Type Unspecified