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General NPI Number Information
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NPI Number | 1265620066
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Entity Type | Organization
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Legal Business Name | PERRY B HERSON MD PC
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 99 HILLSIDE AVE SUITE 99F
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City | WILLISTON PARK
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State | NY
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Zip | 11596-2333
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Country | US
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Telephone | 516-746-0772
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Fax | 516-746-0310
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Provider Business Mailing Address
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Address Line | 99 HILLSIDE AVE SUITE 99F
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City | WILLISTON PARK
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State | NY
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Zip | 11596-2333
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Country | US
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Telephone | 516-746-0772
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Fax | 516-746-0310
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. CARA MUNOZ-VOGT
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Credential | OM
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Telephone | 516-746-0772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 201461
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License Number State | NY
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