Healthcare Provider Details

I. General information

NPI: 1912014010
Provider Name (Legal Business Name): EUGENE GEORGE HERMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 N CENTRE AVE STE 303
ROCKVILLE CENTRE NY
11570-3923
US

IV. Provider business mailing address

77 N CENTRE AVE STE 303
ROCKVILLE CENTRE NY
11570-3923
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-3330
  • Fax: 516-766-3563
Mailing address:
  • Phone: 516-766-3330
  • Fax: 516-766-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number032691-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: