Healthcare Provider Details

I. General information

NPI: 1174832133
Provider Name (Legal Business Name): DEBORAH J HERDAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHURCH ST, 5TH FLOOR PUBLIC HEALTH SOLUTIONS-MIC WOMEN'S HEALTH SERVICES
NEW YORK NY
10013-2988
US

IV. Provider business mailing address

220 CHURCH ST, 5TH FLOOR PUBLIC HEALTH SOLUTIONS-MIC WOMEN'S HEALTH SERVICES
NEW YORK NY
10013
US

V. Phone/Fax

Practice location:
  • Phone: 646-619-6688
  • Fax: 646-619-6782
Mailing address:
  • Phone: 646-619-6688
  • Fax: 646-619-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000749
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: