Provider Demographics
NPI:1659846277
Name:HELLER, GARY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:HELLER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 5TH AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6575
Mailing Address - Country:US
Mailing Address - Phone:212-759-2282
Mailing Address - Fax:212-379-2123
Practice Address - Street 1:57 W 5TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:646-790-7464
Practice Address - Fax:212-379-2075
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043594-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic