Healthcare Provider Details

I. General information

NPI: 1164424958
Provider Name (Legal Business Name): DANIEL J HERERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 GRAND AVE SUITE 220
ENGLEWOOD NJ
07631-3574
US

IV. Provider business mailing address

59 CHURCH ST.
ALPINE NJ
07620
US

V. Phone/Fax

Practice location:
  • Phone: 201-503-1900
  • Fax: 201-503-1901
Mailing address:
  • Phone: 201-784-6012
  • Fax: 201-784-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA07569100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: