Individual
MICHAEL HERCEG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
33 MITCHELL AVE, SUITE 207, BINGHAMTON, NY 13903-1674
(607) 723-7586
(607) 723-1989
Mailing address
22 PINE MEADOW RD, VESTAL, NY 13850-3042
(607) 217-5372
(607) 723-1989
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
247466-1
NY
207W00000X
Ophthalmology Physician
OS014046
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02061489
MEDICAID GROUP ID
NY
05
—
02992038
—
NY
01
—
AA0477
MEDICARE GROUP PROVIDER
NY
Enumeration date
05/02/2007
Last updated
06/29/2016
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