Provider Demographics
NPI:1174393821
Name:HERMANSKY, BLAIR (CORT)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:HERMANSKY
Suffix:
Gender:F
Credentials:CORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CREEKSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1339
Mailing Address - Country:US
Mailing Address - Phone:856-745-7187
Mailing Address - Fax:
Practice Address - Street 1:1307 WHITE HORSE RD STE C501
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2176
Practice Address - Country:US
Practice Address - Phone:856-784-2659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ714965208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery