Provider Demographics
NPI:1871702514
Name:HERZLICH, JEFFREY (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:HERZLICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8437 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1643
Mailing Address - Country:US
Mailing Address - Phone:718-805-1010
Mailing Address - Fax:718-805-1038
Practice Address - Street 1:8437 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1643
Practice Address - Country:US
Practice Address - Phone:718-805-1010
Practice Address - Fax:718-805-1038
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0060755OtherGHI
NY590465OtherUNITED
NYP1859485OtherOXFORD
NY221872OtherAETNA US HEALTHCARE
NY231571OtherWORKERS COMPENSATION
NY837562OtherFIRST HEALTH NETWORK
NYX21501OtherBLUE CROSS BLUE SHIELD
NY4509395OtherAETNA US HEALTHCARE
NY837562OtherFIRST HEALTH NETWORK