MEDICARE: T.F. HERCEG INC.

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1174603880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T.F. HERCEG INC.

Provider Business Mailing Address
First Line	:	982 COUNTY ROUTE 1
Second Line	:
City	:	PINE ISLAND
State	:	NY
Zip	:	10969
Country	:	US
Telephone Number	:	854-258-6500
Fax Number	:	845-258-6634

Provider Business Practice Location Address
First Line	:	982 COUNTY ROUTE 1
Second Line	:
City	:	PINE ISLAND
State	:	NY
Zip	:	10969-1205
Country	:	US
Telephone Number	:	854-258-6500
Fax Number	:	845-258-6634

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS F HERCEG
Credential	:
Telephone Number	:	800-724-5305

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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