Provider Demographics
NPI:1821084237
Name:HELLER, LOUIS I (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:I
Last Name:HELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19 BRADHURST AVE STE 3100N
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:111 MARYS AVE STE 3
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5896
Practice Address - Country:US
Practice Address - Phone:453-393-6638
Practice Address - Fax:845-339-3629
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA45238207RI0011X, 207RC0000X, 207UN0901X
NY150444207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000784935FMedicaid
A62168Medicare UPIN