MEDICARE: DR. SCOTT A HERNBERG D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	25MB04215800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538164009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT A HERNBERG D.O.

Provider Business Mailing Address
First Line	:	1750 ZION RD STE 204
Second Line	:
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-1844
Country	:	US
Telephone Number	:	609-407-1119
Fax Number	:	609-407-1338

Provider Business Practice Location Address
First Line	:	1750 ZION RD STE 4
Second Line	:
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-1844
Country	:	US
Telephone Number	:	609-407-1119
Fax Number	:	609-407-1138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	06/25/2025

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