Healthcare Provider Details

I. General information

NPI: 1699783019
Provider Name (Legal Business Name): JERALD BRUCE HERSHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEMERCURIO DR
ALLENDALE NJ
07401-1717
US

IV. Provider business mailing address

ONE DEMERCURIO DR
ALLENDALE NJ
07401
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-1800
  • Fax: 201-327-7747
Mailing address:
  • Phone: 201-327-1800
  • Fax: 201-327-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA039939
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: