Provider Demographics
NPI:1518035112
Name:HEYBURN, DONALD J (ATC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:J
Last Name:HEYBURN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SAILER ST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2547
Mailing Address - Country:US
Mailing Address - Phone:908-272-1416
Mailing Address - Fax:
Practice Address - Street 1:100 HORSENECK RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9626
Practice Address - Country:US
Practice Address - Phone:973-331-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00099700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist