Healthcare Provider Details

I. General information

NPI: 1144989401
Provider Name (Legal Business Name): HERSHCOVITCH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST STE 300
BURBANK CA
91505-4580
US

IV. Provider business mailing address

201 S BUENA VISTA ST STE 300
BURBANK CA
91505-4580
US

V. Phone/Fax

Practice location:
  • Phone: 520-979-6774
  • Fax:
Mailing address:
  • Phone: 818-206-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICIA BROSIUS
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-206-2539