Provider Demographics
NPI:1902102742
Name:IZAK HERSCHITZ MD PC
Entity Type:Organization
Organization Name:IZAK HERSCHITZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IZAK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSCHITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-332-1777
Mailing Address - Street 1:1150 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5901
Mailing Address - Country:US
Mailing Address - Phone:718-332-1777
Mailing Address - Fax:718-332-3913
Practice Address - Street 1:1150 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5901
Practice Address - Country:US
Practice Address - Phone:718-332-1777
Practice Address - Fax:718-332-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138318207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty