Provider Demographics
NPI:1437198702
Name:HERBST, ANDREW M (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:HERBST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-5813
Mailing Address - Country:US
Mailing Address - Phone:212-772-9471
Mailing Address - Fax:
Practice Address - Street 1:13 PARK ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4811
Practice Address - Country:US
Practice Address - Phone:212-772-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY208616207ND0101X
CT044188207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2K4491Medicare ID - Type Unspecified
NYH34298Medicare UPIN