Provider Demographics
NPI:1730133562
Name:HEIGHTS MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:HEIGHTS MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-288-6364
Mailing Address - Street 1:288 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1315
Mailing Address - Country:US
Mailing Address - Phone:201-288-6781
Mailing Address - Fax:201-288-2734
Practice Address - Street 1:288 BOULEVARD
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1315
Practice Address - Country:US
Practice Address - Phone:201-288-6781
Practice Address - Fax:201-288-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ21636207Q00000X
NJ39369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0113810001OtherAMERIHEALTH ID
NJ2874407Medicaid
NJ2874407Medicaid
NJ0113810001OtherAMERIHEALTH ID