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General NPI Number Information
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NPI Number | 1164424958
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Entity Type | Individual
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Provider Name | DANIEL J HERERA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 07/07/2011
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Provider Practice Location Address
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Address Line | 106 GRAND AVE SUITE 220
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3574
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Country | US
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Telephone | 201-503-1900
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Fax | 201-503-1901
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Provider Business Mailing Address
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Address Line | 59 CHURCH ST.
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City | ALPINE
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State | NJ
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Zip | 07620
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Country | US
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Telephone | 201-784-6012
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Fax | 201-784-4087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MA07569100
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License Number State | NJ
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