Provider Demographics
NPI:1477589612
Name:HELLER, ALLISON GRACE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:GRACE
Last Name:HELLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MIDDLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2200
Mailing Address - Country:US
Mailing Address - Phone:631-261-4400
Mailing Address - Fax:631-486-6106
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:VETERANS ADMINISTRATION MEDICAL CENTER
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-266-6054
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301004363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner