Healthcare Provider Details

I. General information

NPI: 1952383663
Provider Name (Legal Business Name): MARC BENJAMIN HERTZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 OCEAN AVE SUITE 1K
BROOKLYN NY
11230-7352
US

IV. Provider business mailing address

1517 E 5TH ST
BROOKLYN NY
11230-6339
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-9999
  • Fax: 718-998-9999
Mailing address:
  • Phone: 718-998-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number046617
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: