Provider Demographics
NPI:1417181405
Name:HEDDEN, JEFFREY LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LOUIS
Last Name:HEDDEN
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 1:17 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-4007
Mailing Address - Country:US
Mailing Address - Phone:518-798-0767
Mailing Address - Fax:518-798-0815
Practice Address - Street 1:17 MAIN ST
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-4007
Practice Address - Country:US
Practice Address - Phone:518-798-0767
Practice Address - Fax:518-798-0815
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267496208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation