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General NPI Number Information
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NPI Number | 1548389042
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Entity Type | Individual
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Provider Name | MICHAEL HERSKOVICS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2572 E 15TH ST
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City | BROOKLYN
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State | NY
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Zip | 11235-3504
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Country | US
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Telephone | 718-743-4276
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Fax | 718-743-8659
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Provider Business Mailing Address
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Address Line | 219 HUNTLEY RD
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City | WOODMERE
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State | NY
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Zip | 11598-2514
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Country | US
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Telephone | 516-295-5036
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Fax | 516-295-0448
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7984
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License Number State | NY
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