Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD028669E | PA |
NPI | 1033182324 |
---|---|
Provider Name | Jonathan Hertz |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18103-6224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 03/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009153070006 | (05) | PA |
C29671 | (02) |