MEDICARE: RICHARD J 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	2085R0202X	Diagnostic Radiology Physician	206121	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548263338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J HERZOG M.D.

Provider Business Mailing Address
First Line	:	535 E 70TH ST
Second Line	:	DIVISION OF MRI
City	:	NEW YORK
State	:	NY
Zip	:	10021-4872
Country	:	US
Telephone Number	:	212-774-2251
Fax Number	:	212-734-7378

Provider Business Practice Location Address
First Line	:	535 E 70TH ST
Second Line	:	DIVISION OF MRI
City	:	NEW YORK
State	:	NY
Zip	:	10021-4872
Country	:	US
Telephone Number	:	212-774-2251
Fax Number	:	212-734-7378

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/08/2021

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