Healthcare Provider Details

I. General information

NPI: 1538164009
Provider Name (Legal Business Name): SCOTT A HERNBERG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 ZION RD STE 4
NORTHFIELD NJ
08225-1844
US

IV. Provider business mailing address

1750 ZION RD STE 204
NORTHFIELD NJ
08225-1844
US

V. Phone/Fax

Practice location:
  • Phone: 609-407-1119
  • Fax: 609-407-1138
Mailing address:
  • Phone: 609-407-1119
  • Fax: 609-407-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MB04215800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: