Provider Demographics
NPI:1780906263
Name:STANLEY HERSCHBERG D.O.P.S.
Entity type:Organization
Organization Name:STANLEY HERSCHBERG D.O.P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSCHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:206-362-6300
Mailing Address - Street 1:10564 5TH AVE NE STE 401
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7200
Mailing Address - Country:US
Mailing Address - Phone:206-362-6300
Mailing Address - Fax:206-362-6301
Practice Address - Street 1:10564 5TH AVE NE STE 401
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7200
Practice Address - Country:US
Practice Address - Phone:206-362-6300
Practice Address - Fax:206-362-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA40000692261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1366905Medicaid
WA1366905Medicaid