MEDICARE: NITZA HERTZ

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	235Z00000X	Speech-Language Pathologist	013466-1	NY

General Provider Information

NPI Number	:	1821303058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NITZA HERTZ

Provider Business Mailing Address
First Line	:	1347 E 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5703
Country	:	US
Telephone Number	:	347-254-0474
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 CONEY ISLAND AVE
Second Line	:	OMNI CHILDHOOD CENTER
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5703
Country	:	US
Telephone Number	:	718-998-1415
Fax Number	:

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

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	08/12/2010

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Directions to “ NITZA HERTZ ” Practice Location

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