Provider Demographics
NPI:1417092875
Name:HEIDER, GERTI ELISABETH (PHD, APRN, BC)
Entity Type:Individual
Prefix:
First Name:GERTI
Middle Name:ELISABETH
Last Name:HEIDER
Suffix:
Gender:F
Credentials:PHD, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 GREEN POND RD
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07435-1215
Mailing Address - Country:US
Mailing Address - Phone:973-697-9283
Mailing Address - Fax:973-208-1988
Practice Address - Street 1:505 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1623
Practice Address - Country:US
Practice Address - Phone:201-684-7206
Practice Address - Fax:201-684-7954
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06741100363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology