Healthcare Provider Details

I. General information

NPI: 1427445204
Provider Name (Legal Business Name): PAUL M HERTZ DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 RIVERDALE AVENUE
RIVERDALE NY
10471
US

IV. Provider business mailing address

6011 RIVERDALE AVENUE
RIVERDALE NY
10471
US

V. Phone/Fax

Practice location:
  • Phone: 718-432-9900
  • Fax: 718-432-9903
Mailing address:
  • Phone: 718-432-9900
  • Fax: 718-432-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number040306
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number040306
License Number StateNY

VIII. Authorized Official

Name: DR. PAUL M HERTZ
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 748-432-9900