Provider Demographics
NPI:1619993623
Name:HECKER, HENRY C (PT)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:C
Last Name:HECKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 PALISADE AVE
Mailing Address - Street 2:10J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6106
Mailing Address - Country:US
Mailing Address - Phone:917-334-0185
Mailing Address - Fax:718-796-7806
Practice Address - Street 1:1 LARCH DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1907
Practice Address - Country:US
Practice Address - Phone:917-334-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00995937Medicaid
NYR26943Medicare UPIN
NYQL7051Medicare ID - Type UnspecifiedPHYSICAL THERAPY