Healthcare Provider Details

I. General information

NPI: 1578839874
Provider Name (Legal Business Name): SEAN BLAKE HERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAY AVE STE 4
MONTCLAIR NJ
07042-4837
US

IV. Provider business mailing address

200 SCHULZ DR STE 2
RED BANK NJ
07701-6745
US

V. Phone/Fax

Practice location:
  • Phone: 732-426-3420
  • Fax:
Mailing address:
  • Phone: 732-242-7068
  • Fax: 848-800-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25MA10644700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: