Healthcare Provider Details

I. General information

NPI: 1437140761
Provider Name (Legal Business Name): LUIS OSCAR HERRERA-ACEVEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 CHURCH ST
FREEPORT NY
11520-3830
US

IV. Provider business mailing address

857 CLIFFSIDE AVE
NORTH WOODMERE NY
11581-3001
US

V. Phone/Fax

Practice location:
  • Phone: 516-223-2900
  • Fax: 516-223-7320
Mailing address:
  • Phone: 516-791-5919
  • Fax: 516-223-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number196850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: