Provider Demographics
NPI:1356306617
Name:HEFFERNAN, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HEFFERNAN
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 1:514 STATE ROUTE 299
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2835
Mailing Address - Country:US
Mailing Address - Phone:845-691-9200
Mailing Address - Fax:845-691-3992
Practice Address - Street 1:514 STATE ROUTE 299
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2835
Practice Address - Country:US
Practice Address - Phone:845-691-9200
Practice Address - Fax:845-691-3992
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00891098Medicaid
A62775Medicare UPIN
NY44D621Medicare PIN