MEDICARE: DR. MORTON HERTZ DDS

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	1223G0001X	General Practice Dentistry	032988-1	NY

General Provider Information

NPI Number	:	1104038504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORTON HERTZ DDS

Provider Business Mailing Address
First Line	:	35 TOP O THE RIDGE DR
Second Line	:
City	:	SCARSDALE
State	:	NY
Zip	:	10583-6715
Country	:	US
Telephone Number	:	914-723-9207
Fax Number	:

Provider Business Practice Location Address
First Line	:	3156 STEINWAY ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3909
Country	:	US
Telephone Number	:	718-721-4700
Fax Number	:

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

Provider Enumeration Date	:	05/06/2007
Last Update Date	:	07/08/2007

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