Healthcare Provider Details

I. General information

NPI: 1275986473
Provider Name (Legal Business Name): ILANA HERZBERG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 MORRIS TPKE STE 207
SHORT HILLS NJ
07078-2617
US

IV. Provider business mailing address

110 WHITE ROCK RD APT 3111
VERONA NJ
07044-1525
US

V. Phone/Fax

Practice location:
  • Phone: 908-414-0319
  • Fax:
Mailing address:
  • Phone: 908-414-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: