Provider Demographics
NPI:1790780575
Name:HELLER, DAVID P (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:HELLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:P
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:26 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6034
Mailing Address - Country:US
Mailing Address - Phone:908-770-8158
Mailing Address - Fax:732-873-2751
Practice Address - Street 1:807A UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3410
Practice Address - Country:US
Practice Address - Phone:718-345-8923
Practice Address - Fax:718-342-7111
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002579213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00413552Medicaid
NJ0805180003Medicare NSC
NY480030052Medicare PIN
NJ695569Medicare PIN
NYP29221Medicare ID - Type Unspecified
NY00413552Medicaid
NY0805180001Medicare NSC