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General NPI Number Information
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NPI Number | 1144989401
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Entity Type | Organization
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Legal Business Name | HERSHCOVITCH MD PC
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 201 S BUENA VISTA ST STE 300
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City | BURBANK
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State | CA
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Zip | 91505-4580
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Country | US
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Telephone | 520-979-6774
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S BUENA VISTA ST STE 300
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City | BURBANK
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State | CA
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Zip | 91505-4580
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Country | US
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Telephone | 818-206-2539
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALICIA BROSIUS
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Credential |
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Telephone | 818-206-2539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State |
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