Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 226879 | NY |
NPI | 1306867494 |
---|---|
Provider Name | Amir Herman |
First Address | East Northport, NY 11731-4205 |
Second Address | East Northport, NY 11731-4205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 06/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I50298 | (02) | NY |