MEDICARE: DR. LEROY HERBERT 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	207RN0300X	Nephrology Physician	186982-1	NY

General Provider Information

NPI Number	:	1285635953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEROY HERBERT MD

Provider Business Mailing Address
First Line	:	2615 FREDERICK DOUGLAS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030
Country	:	US
Telephone Number	:	212-281-8200
Fax Number	:	212-281-8301

Provider Business Practice Location Address
First Line	:	2615 FREDERICK BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030
Country	:	US
Telephone Number	:	212-281-8200
Fax Number	:	212-281-8301

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	03/28/2008

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