Provider Demographics
NPI:1447026042
Name:HERZOG, ROBERT HERZOG
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HERZOG
Last Name:HERZOG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 KILMER CT
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-2303
Mailing Address - Country:US
Mailing Address - Phone:973-769-6624
Mailing Address - Fax:
Practice Address - Street 1:3 KILMER CT
Practice Address - Street 2:
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-2303
Practice Address - Country:US
Practice Address - Phone:973-769-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14962800363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care