Healthcare Provider Details

I. General information

NPI: 1396281853
Provider Name (Legal Business Name): MICHAEL HERMAN DDS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 CENTRAL PARK S SUITE 1A
NEW YORK NY
10019-1565
US

IV. Provider business mailing address

128 CENTRAL PARK S SUITE 1A
NEW YORK NY
10019-1565
US

V. Phone/Fax

Practice location:
  • Phone: 212-582-3322
  • Fax: 212-582-3784
Mailing address:
  • Phone: 212-582-3322
  • Fax: 212-582-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL HERMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 212-582-3322