Provider Demographics
NPI:1033470208
Name:ZWILLICK, HEATHER ANN
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN
Last Name:ZWILLICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:FERRIZZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7505 210TH ST
Mailing Address - Street 2:APT 2 L
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7505 210TH ST
Practice Address - Street 2:APT 2 L
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3249
Practice Address - Country:US
Practice Address - Phone:516-991-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist