Mark Alan Hertzberg, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

004131 Issued in NY

Practice address

25301 Rockaway Blvd
Rosedale, NY 11422-3113

Phone

(516) 295-2135

Fax

(516) 295-4561

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305590400000",
    "number": "1114134962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 461",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115590461",
            "telephone_number": "718-327-1536",
            "fax_number": "718-327-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25301 ROCKAWAY BLVD",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114223113",
            "telephone_number": "516-295-2135",
            "fax_number": "516-295-4561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERTZBERG",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2011-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "004131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Rosedale, NY
• Providers in Rosedale, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.