Physician Compare National (NPI:1083724124)

HEALTHCARE PROVIDER: THEODORE L HERNITCHE JR. LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1083724124
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9739453846
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180327000126
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HERNITCHE
	Individual professional last name
Provider First Name	THEODORE
	Individual professional first name
Provider Middle Name	LAWRENCE
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	180 E MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	SMITHTOWN
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	117872800
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6318632499
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y