Provider Demographics
NPI:1053958983
Name:HERRMANN, MARY LYNN (RNFA)
Entity type:Individual
Prefix:
First Name:MARY LYNN
Middle Name:
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1015
Mailing Address - Country:US
Mailing Address - Phone:908-337-5889
Mailing Address - Fax:
Practice Address - Street 1:825 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1366
Practice Address - Country:US
Practice Address - Phone:973-857-9499
Practice Address - Fax:973-857-9453
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO07808400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery