MEDICARE: DR. KENNETH L HERMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	25MB0479100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8107509004	OTHER	NJ	CIGNA
2	0693784000	OTHER	NJ	AMERIHEALTH
3	24034	OTHER	NJ	AETNA US HEALTHCARE
4	751636	OTHER	NJ	BLUE SHIELD

General Provider Information

NPI Number	:	1013998756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH L HERMAN D.O.

Provider Business Mailing Address
First Line	:	17 W RED BANK AVE
Second Line	:	SUITE 205
City	:	WOODBURY
State	:	NJ
Zip	:	08096-1630
Country	:	US
Telephone Number	:	856-853-0900
Fax Number	:	856-853-5838

Provider Business Practice Location Address
First Line	:	17 W RED BANK AVE
Second Line	:	SUITE 205
City	:	WOODBURY
State	:	NJ
Zip	:	08096-1630
Country	:	US
Telephone Number	:	856-853-0900
Fax Number	:	856-853-5838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/11/2013

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