Provider Demographics
NPI:1639142128
Name:HEFTLER, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:HEFTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GREENWICH OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5151
Mailing Address - Country:US
Mailing Address - Phone:203-869-1145
Mailing Address - Fax:203-618-1721
Practice Address - Street 1:6 GREENWICH OFFICE PARK
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5151
Practice Address - Country:US
Practice Address - Phone:203-869-1145
Practice Address - Fax:203-618-1721
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043021208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP00640491OtherRAILROAD MEDICARE PTAN
CTH68794Medicare UPIN
CT250000350Medicare ID - Type Unspecified