Provider Demographics
NPI:1083813836
Name:PETER J HEFFER MDPC
Entity Type:Organization
Organization Name:PETER J HEFFER MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-961-5722
Mailing Address - Street 1:14207 BOOTH MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5343
Mailing Address - Country:US
Mailing Address - Phone:718-961-5722
Mailing Address - Fax:718-321-3099
Practice Address - Street 1:142 07 BOOTH MEM AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5343
Practice Address - Country:US
Practice Address - Phone:718-961-5722
Practice Address - Fax:718-321-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00884973Medicaid
NY87696Medicare PIN
NYB88828Medicare UPIN