Provider Demographics
NPI:1780062554
Name:HERMAN, MORGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CENTRAL PARK S
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1565
Mailing Address - Country:US
Mailing Address - Phone:212-582-6603
Mailing Address - Fax:
Practice Address - Street 1:128 CENTRAL PARK S
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1565
Practice Address - Country:US
Practice Address - Phone:212-582-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program