MEDICARE: DR. DAVID M HERZOG 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	207V00000X	Obstetrics & Gynecology Physician	172295	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487618468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID M HERZOG M.D.

Provider Business Mailing Address
First Line	:	1855 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3909
Country	:	US
Telephone Number	:	718-761-7212
Fax Number	:	718-351-1693

Provider Business Practice Location Address
First Line	:	1855 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3909
Country	:	US
Telephone Number	:	718-761-7212
Fax Number	:	718-351-1693

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	06/27/2013

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