MEDICARE: MRS. MARTHA L HERRERA-ROJAS PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant	014399	NY

General Provider Information

NPI Number	:	1659670693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA L HERRERA-ROJAS PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	531 MOUNTAIN AVE
Second Line	:
City	:	NORTH CALDWELL
State	:	NJ
Zip	:	07006-4567
Country	:	US
Telephone Number	:	973-204-6456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1381 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-4101
Country	:	US
Telephone Number	:	718-892-5500
Fax Number	:

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

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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