Provider Demographics
NPI:1841470291
Name:NEIL F HERTZBERG DPM
Entity type:Organization
Organization Name:NEIL F HERTZBERG DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:FARREL
Authorized Official - Last Name:HERTZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-569-9920
Mailing Address - Street 1:6689 ORCHARD LAKE RD STE 275
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3404
Mailing Address - Country:US
Mailing Address - Phone:248-569-9920
Mailing Address - Fax:248-569-9921
Practice Address - Street 1:5028 VILLAGE SQUARE CIRCLE
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-569-9920
Practice Address - Fax:248-788-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINH000838213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4886350160OtherBLUE CROSS BLUE SHIELD
MI0490420001Medicare NSC
MIT97293Medicare UPIN
MI8635016Medicare PIN