Healthcare Provider Details

I. General information

NPI: 1093788374
Provider Name (Legal Business Name): DAVID A HERZOG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THEALL RD
RYE NY
10580-1404
US

IV. Provider business mailing address

210 WESTCHESTER AVE THE WESTCHESTER MEDICAL GROUP
WHITE PLAINS NY
10604
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8700
  • Fax: 914-682-6403
Mailing address:
  • Phone: 914-682-6538
  • Fax: 914-682-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number151221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: