Healthcare Provider Details

I. General information

NPI: 1326081001
Provider Name (Legal Business Name): JERRY HERSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VICENZA HEALTH CLINIC VICENZA HEALTH CLINIC, VICENZA, ITALY
APO AE NY
09630-0016
US

IV. Provider business mailing address

CMR 427 BOX 1559
APO AE NY
09630-0016
US

V. Phone/Fax

Practice location:
  • Phone: 44-471-8301
  • Fax: 44-471-8210
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2004-0069
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: