Provider Demographics
NPI:1629153036
Name:HEFFRON, MARK STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:HEFFRON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 211TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1012
Mailing Address - Country:US
Mailing Address - Phone:718-464-8948
Mailing Address - Fax:718-740-0319
Practice Address - Street 1:8003 211TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1012
Practice Address - Country:US
Practice Address - Phone:718-464-8948
Practice Address - Fax:718-740-0319
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002652111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11-2847332OtherTAX ID
NY0079854OtherGHI PROVIDER NUMBER
NY08397Medicare PIN