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Provider Information for 1942376389



DR. GARY HERSKOVITS DDS

Gender: MALE

Individual NPI: 1942376389

Calendar Last Updated: 2015-02-16

Details

Name Value
NPI 1942376389
Enumeration Date 2006-11-28
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 9412 4TH AVE
BROOKLYN, NY 11209
United States

Phone: 718-745-3456 | Fax:
View Map External Link
Primary Practice Address 9412 4TH AVE
BROOKLYN, NY 11209
United States

Phone: 718-745-3456 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID NY 00671150
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist NY 36187