Provider Demographics
NPI:1467467175
Name:JON S HEIST DO PA
Entity Type:Organization
Organization Name:JON S HEIST DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEIST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-881-8618
Mailing Address - Street 1:361 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028
Mailing Address - Country:US
Mailing Address - Phone:856-881-8618
Mailing Address - Fax:856-881-5368
Practice Address - Street 1:361 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028
Practice Address - Country:US
Practice Address - Phone:856-881-8618
Practice Address - Fax:856-881-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8091609Medicaid
F81713Medicare UPIN
NJ034286SV7Medicare ID - Type Unspecified