MEDICARE: DR. ILENE M HERSHMAN MD

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	2080A0000X	Pediatric Adolescent Medicine Physician	MA41952	NJ

General Provider Information

NPI Number	:	1255300059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ILENE M HERSHMAN MD

Provider Business Mailing Address
First Line	:	181 US HIGHWAY 46
Second Line	:
City	:	MINE HILL
State	:	NJ
Zip	:	07803-3133
Country	:	US
Telephone Number	:	973-361-1081
Fax Number	:	973-361-2415

Provider Business Practice Location Address
First Line	:	181 US HIGHWAY 46
Second Line	:
City	:	MINE HILL
State	:	NJ
Zip	:	07803-3133
Country	:	US
Telephone Number	:	973-361-1081
Fax Number	:	973-361-2415

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	07/08/2007

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