Provider Demographics
NPI:1508907692
Name:HERITAGE INTEGRATED HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:HERITAGE INTEGRATED HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEBOLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ORAFIDIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-230-5885
Mailing Address - Street 1:34 PLAZA ST E
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5038
Mailing Address - Country:US
Mailing Address - Phone:718-230-5885
Mailing Address - Fax:718-230-4260
Practice Address - Street 1:34 PLAZA ST E
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5038
Practice Address - Country:US
Practice Address - Phone:718-230-5885
Practice Address - Fax:718-230-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203946305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01733531Medicaid
NY01733531Medicaid
18X332Medicare PIN