Provider Demographics
NPI:1053591107
Name:HERZBERGER, JAMES W (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:HERZBERGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:820 N MANHATTAN AVE
Mailing Address - Street 2:APT D4
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5211
Mailing Address - Country:US
Mailing Address - Phone:404-783-4154
Mailing Address - Fax:
Practice Address - Street 1:820 N MANHATTAN AVE
Practice Address - Street 2:APT D4
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5211
Practice Address - Country:US
Practice Address - Phone:404-783-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant