Healthcare Provider Details

I. General information

NPI: 1114853181
Provider Name (Legal Business Name): EMILY NANCY HERBST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MAIN ST STE 1
FARMINGDALE NJ
07727-1341
US

IV. Provider business mailing address

43 MAIN ST STE 1
FARMINGDALE NJ
07727-1341
US

V. Phone/Fax

Practice location:
  • Phone: 732-938-6471
  • Fax: 833-488-1209
Mailing address:
  • Phone: 732-938-6471
  • Fax: 833-488-1209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01041400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: