Provider Demographics
NPI:1730266107
Name:HERRERA, MARIA A (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 MORELAND RD STE 8
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3922
Mailing Address - Country:US
Mailing Address - Phone:631-517-9261
Mailing Address - Fax:631-517-9276
Practice Address - Street 1:201 MORELAND RD STE 8
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3922
Practice Address - Country:US
Practice Address - Phone:631-517-9261
Practice Address - Fax:631-517-9276
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY219249208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH26521Medicare UPIN