Provider Demographics
NPI:1659368314
Name:HEISLER, LOUIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:R
Last Name:HEISLER
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 1:410 LAKEVILLE RD
Mailing Address - Street 2:YUINS, ROBERTS & BURRAU, PC
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1101
Mailing Address - Country:US
Mailing Address - Phone:516-488-5050
Mailing Address - Fax:516-356-6252
Practice Address - Street 1:910 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11040-3008
Practice Address - Country:US
Practice Address - Phone:516-488-5050
Practice Address - Fax:516-326-6252
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYGO120352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B13168Medicare UPIN
33091LMedicare ID - Type Unspecified