Provider Demographics
NPI:1154687473
Name:HERMANN, JOHN ALEXANDER
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:HERMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 BICYCLE PATH
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3409
Mailing Address - Country:US
Mailing Address - Phone:631-627-9666
Mailing Address - Fax:631-677-3211
Practice Address - Street 1:452 BICYCLE PATH
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3409
Practice Address - Country:US
Practice Address - Phone:631-721-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion