Provider Demographics
NPI:1508566670
Name:HERITAGE MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:HERITAGE MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-537-5555
Mailing Address - Street 1:180 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CTR
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4711
Mailing Address - Country:US
Mailing Address - Phone:770-537-5555
Mailing Address - Fax:770-537-0548
Practice Address - Street 1:180 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CTR
Practice Address - State:NY
Practice Address - Zip Code:11570-4711
Practice Address - Country:US
Practice Address - Phone:770-537-5555
Practice Address - Fax:770-537-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty