Provider Demographics
NPI:1538164009
Name:HERNBERG, SCOTT A (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:HERNBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 ZION RD STE 204
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1844
Mailing Address - Country:US
Mailing Address - Phone:609-407-1119
Mailing Address - Fax:609-407-1338
Practice Address - Street 1:1750 ZION RD STE 4
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1844
Practice Address - Country:US
Practice Address - Phone:609-407-1119
Practice Address - Fax:609-407-1138
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04215800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2222205Medicaid
NJ2222205Medicaid
A10560Medicare UPIN