Healthcare Provider Details

I. General information

NPI: 1336243419
Provider Name (Legal Business Name): AHVIE HERSKOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2058 12TH AVE
SAN FRANCISCO CA
94116-1306
US

IV. Provider business mailing address

2058 12TH AVE
SAN FRANCISCO CA
94116-1306
US

V. Phone/Fax

Practice location:
  • Phone: 415-759-8150
  • Fax: 415-759-8161
Mailing address:
  • Phone: 415-759-8150
  • Fax: 415-759-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC050117
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC050117
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberC050117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: