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General NPI Number Information
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NPI Number | 1427292614
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Entity Type | Individual
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Provider Name | KERI ALISSA HERZOG M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 1224 MAIN ST
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City | BRANFORD
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State | CT
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Zip | 06405-3778
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Country | US
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Telephone | 203-481-0315
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Fax | 203-488-6945
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Provider Business Mailing Address
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Address Line | 687 MAIN ST
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City | BRANFORD
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State | CT
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Zip | 06405-3612
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Country | US
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Telephone | 203-481-7050
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Fax | 203-488-6945
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 54855
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License Number State | CT
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