Provider Demographics
NPI:1932108834
Name:HERRERA, NILO E JR (MD)
Entity Type:Individual
Prefix:
First Name:NILO
Middle Name:E
Last Name:HERRERA
Suffix:JR
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 1:110 S BEDFORD RD
Mailing Address - Street 2:CAREMOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:2050 ROUTE 22
Practice Address - Street 2:SUITE 101
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5948
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:845-278-7254
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00932783Medicaid
NY22D091Medicare PIN
E53594Medicare UPIN
NY00932783Medicaid