Provider Demographics
NPI:1770519407
Name:STEVEN P. HERMAN, M.D.
Entity type:Organization
Organization Name:STEVEN P. HERMAN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-649-7722
Mailing Address - Street 1:5893 CAMP RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4470
Mailing Address - Country:US
Mailing Address - Phone:716-649-7722
Mailing Address - Fax:716-649-7950
Practice Address - Street 1:5893 CAMP RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4470
Practice Address - Country:US
Practice Address - Phone:716-649-7722
Practice Address - Fax:716-649-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0108446OtherINDEPENDENT HEALTH
NY000510065002OtherBLUE CROSS
NY00010075601OtherUNIVERA
NYB36020Medicare UPIN
NY000510065002OtherBLUE CROSS