Basic Information
| Provider Information | |||||||||
| NPI: | 1649515792 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL PRACTICE OF WILFRID HERARD, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112264403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186932800 | ||||||||
| FaxNumber: | 9787016012 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112264403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186932800 | ||||||||
| FaxNumber: | 9787016012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2012 | ||||||||
| LastUpdateDate: | 11/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | HERARD | ||||||||
| AuthorizedOfficialFirstName: | WILFRID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INTERNAL MEDICINE-PULMONARY DISEASE | ||||||||
| AuthorizedOfficialTelephone: | 7186932800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 175218 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 01450453 | 05 | NY | MEDICAID |