Provider Demographics
NPI: | 1629379128 |
---|---|
Name: | ALAN M. HELLER M.D. INC |
Entity Type: | Organization |
Organization Name: | ALAN M. HELLER M.D. INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ALAN |
Authorized Official - Middle Name: | MAX |
Authorized Official - Last Name: | HELLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 408-297-6030 |
Mailing Address - Street 1: | 2039 FOREST AVE STE 203 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN JOSE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95128-4815 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 408-297-6030 |
Mailing Address - Fax: | 408-297-8612 |
Practice Address - Street 1: | 2039 FOREST AVE |
Practice Address - Street 2: | 203 |
Practice Address - City: | SAN JOSE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95128-4817 |
Practice Address - Country: | US |
Practice Address - Phone: | 408-297-6030 |
Practice Address - Fax: | 408-297-8612 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-11-15 |
Last Update Date: | 2010-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A 32272 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |