Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 002541 | CT |
N | 103TC0700X | Clinical Psychologist | 002541 | CT |
N | 103G00000X | Clinical Psychologist | 014306-01 | NY |
N | 103TC0700X | Clinical Psychologist | 014306-01 | NY |
Y | 103G00000X | Clinical Psychologist | 0143061 | NY |
Y | 103TC0700X | Clinical Psychologist | 0143061 | NY |
N | 103TR0400X | Rehabilitation Psychologist | 002541 | CT |
NPI | 1275519407 |
---|---|
Provider Name | Dr. Marko S Herceg |
First Address | Irvington, NY 10533-3200 |
Second Address | Irvington, NY 10533-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 11/01/2021 |