Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25MB0479100 | NJ |
NPI | 1013998756 |
---|---|
Provider Name | Dr. Kenneth L Herman |
First Address | Woodbury, NJ 08096-1630 |
Second Address | Woodbury, NJ 08096-1630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 11/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0693784000 | AMERIHEALTH (01) | NJ |
24034 | AETNA US HEALTHCARE (01) | NJ |
751636 | BLUE SHIELD (01) | NJ |
8107509004 | CIGNA (01) | NJ |
B37142 | (02) | NJ |