Provider Demographics
NPI:1215134119
Name:HERRERA, EILEEN BARBARA (NP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:BARBARA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25711 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1019
Mailing Address - Country:US
Mailing Address - Phone:718-347-7399
Mailing Address - Fax:718-347-7840
Practice Address - Street 1:25711 86TH AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1019
Practice Address - Country:US
Practice Address - Phone:718-347-7399
Practice Address - Fax:718-347-7840
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3817711363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics