Provider Demographics
NPI:1215953963
Name:HERZIG, STEVEN A (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:HERZIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 NIBLICK LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-3113
Mailing Address - Country:US
Mailing Address - Phone:203-888-0076
Mailing Address - Fax:203-888-0076
Practice Address - Street 1:353 NIBLICK LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-3113
Practice Address - Country:US
Practice Address - Phone:203-888-0076
Practice Address - Fax:203-888-0076
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D02472Medicare UPIN