MEDICARE: DR. MERYL JEAN NAGOURNEY HERSH DDS

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	122300000X	Dentist	038968	NY

General Provider Information

NPI Number	:	1841314788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERYL JEAN NAGOURNEY HERSH DDS

Provider Business Mailing Address
First Line	:	2176 BERGEN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6219
Country	:	US
Telephone Number	:	718-968-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	4122 QUENTIN RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4322
Country	:	US
Telephone Number	:	718-375-1281
Fax Number	:

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/08/2007

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