Provider Demographics
NPI:1932360997
Name:HERZLICH, ALEXANDRA A (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:A
Last Name:HERZLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5131
Mailing Address - Country:US
Mailing Address - Phone:212-650-0400
Mailing Address - Fax:212-288-4223
Practice Address - Street 1:178 E 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5131
Practice Address - Country:US
Practice Address - Phone:212-650-0400
Practice Address - Fax:212-288-4223
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264955207W00000X, 207WX0120X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400072598Medicare PIN