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General NPI Number Information
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NPI Number | 1760435952
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Entity Type | Individual
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Provider Name | THOMAS HARRY HERZOG MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 3 LYON PLACE
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City | OGDENSBURG
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State | NY
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Zip | 13669
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Country | US
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Telephone | 315-713-6643
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Fax | 866-506-5573
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Provider Business Mailing Address
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Address Line | 3 LYON PLACE
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City | OGDENSBURG
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State | NY
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Zip | 13669
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Country | US
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Telephone | 315-394-7542
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Fax | 866-506-5573
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | ME46735
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 255987
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License Number State | NY
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