Provider Demographics
NPI:1003940818
Name:HESCHELES, DAVID R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:HESCHELES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 BELVEDERE DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-2209
Mailing Address - Country:US
Mailing Address - Phone:631-567-1435
Mailing Address - Fax:
Practice Address - Street 1:273 BELVEDERE DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-2209
Practice Address - Country:US
Practice Address - Phone:631-567-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV12332Medicare ID - Type UnspecifiedPSYCHOLOGIST