Provider Demographics
NPI:1114971827
Name:HEIDEMAN, ALAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:HEIDEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CEDAR GROVE LANE
Mailing Address - Street 2:STE 108
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-560-7172
Mailing Address - Fax:732-560-7181
Practice Address - Street 1:107 CEDAR GROVE LANE
Practice Address - Street 2:STE 108
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-560-7172
Practice Address - Fax:732-560-7181
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA053564002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5503205Medicaid
NJ5503205Medicaid
NJ3000114764Medicare PIN
NJ183812CQHMedicare PIN
NJBH912776OtherDEA