Provider Demographics
NPI:1700225216
Name:HERITAGE BREAST CARE LLC
Entity Type:Organization
Organization Name:HERITAGE BREAST CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BREAST SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHRISTOUDIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-833-2888
Mailing Address - Street 1:741 TEANECK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4243
Mailing Address - Country:US
Mailing Address - Phone:201-833-2888
Mailing Address - Fax:201-833-1010
Practice Address - Street 1:741 TEANECK RD
Practice Address - Street 2:SUITE B
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4243
Practice Address - Country:US
Practice Address - Phone:201-833-2888
Practice Address - Fax:201-833-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty