MEDICARE: DR. STEVEN M. HERZBERG M.D.

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	25MA02980700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F01264	OTHER		HEALTHNET
2	0018242	OTHER		GHI

General Provider Information

NPI Number	:	1093714487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN M. HERZBERG M.D.

Provider Business Mailing Address
First Line	:	1987 DOGWOOD DRIVE
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-4722
Country	:	US
Telephone Number	:	908-789-2478
Fax Number	:	908-789-1510

Provider Business Practice Location Address
First Line	:	1987 DOGWOOD DRIVE
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-4722
Country	:	US
Telephone Number	:	908-789-2478
Fax Number	:	908-789-1510

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/11/2016

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