Provider Demographics
NPI:1417130758
Name:MELTZER TOCCI, HEATHER (BS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MELTZER TOCCI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MELTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:401 FRANKEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 FRANKEL BLVD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5035
Practice Address - Country:US
Practice Address - Phone:516-378-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00276499Medicaid