Provider Demographics
NPI:1659531671
Name:HELLER, MARK L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:HELLER
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 1:1760 2ND AVE
Mailing Address - Street 2:APT 15B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5329
Mailing Address - Country:US
Mailing Address - Phone:212-300-4817
Mailing Address - Fax:
Practice Address - Street 1:1760 2ND AVE
Practice Address - Street 2:APT 15B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5329
Practice Address - Country:US
Practice Address - Phone:212-300-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241296207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine