Provider Demographics
NPI:1154510428
Name:ANDREW J HELLER DPM PC
Entity Type:Organization
Organization Name:ANDREW J HELLER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:661-942-7070
Mailing Address - Street 1:PO BOX 6961
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:661-942-7070
Mailing Address - Fax:661-942-7804
Practice Address - Street 1:1505 W AVE J
Practice Address - Street 2:#203
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-942-7070
Practice Address - Fax:661-942-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2892213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28921Medicaid
CA1146480001Medicare NSC
CAWE2892BMedicare PIN
CA000E28921Medicaid