Provider Demographics
NPI:1659578151
Name:JANE M HEANEY DO PC
Entity Type:Organization
Organization Name:JANE M HEANEY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-483-7200
Mailing Address - Street 1:4000 GYPSY LN UNIT 405
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-5426
Mailing Address - Country:US
Mailing Address - Phone:215-848-4062
Mailing Address - Fax:215-848-4552
Practice Address - Street 1:110 LEVERING ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-1404
Practice Address - Country:US
Practice Address - Phone:215-483-7200
Practice Address - Fax:215-483-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 005958-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2258275001OtherKEYSTONE
PA4547198OtherAETNA
PA00118925-0002Medicaid
PA4547198OtherAETNA
PA2258275001OtherKEYSTONE