Provider Demographics
NPI:1376500702
Name:HELLER, ANDREW S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:HELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:907 N MAIN RD
Mailing Address - Street 2:BLDG C
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8200
Mailing Address - Country:US
Mailing Address - Phone:856-692-7228
Mailing Address - Fax:856-692-4155
Practice Address - Street 1:907 N MAIN RD
Practice Address - Street 2:BLDG C
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8200
Practice Address - Country:US
Practice Address - Phone:856-692-7228
Practice Address - Fax:856-692-4155
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04624200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0238601Medicaid
NJ505695Medicare ID - Type Unspecified
NJ0238601Medicaid