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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
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist NY 36187
Other Identifiers
Issuer State Number
MEDICAID NY 00671150
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location