Provider Demographics
NPI:1447420880
Name:ABRAHAM J. HERZBERG
Entity type:Organization
Organization Name:ABRAHAM J. HERZBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-561-1617
Mailing Address - Street 1:300 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2107
Mailing Address - Country:US
Mailing Address - Phone:516-561-1617
Mailing Address - Fax:
Practice Address - Street 1:300 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2107
Practice Address - Country:US
Practice Address - Phone:516-561-1617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00579722Medicaid
NY00579722Medicaid