Provider Demographics
NPI:1861444358
Name:HEITMANN, JEANNINE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:
Last Name:HEITMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 FRANKLIN AVE
Mailing Address - Street 2:FRANKLIN HOSPITAL EMERGENCY DEPT.
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2145
Mailing Address - Country:US
Mailing Address - Phone:516-256-6353
Mailing Address - Fax:516-256-6347
Practice Address - Street 1:900 FRANKLIN AVE
Practice Address - Street 2:FRANKLIN HOSPITAL EMERGENCY DEPT.
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2145
Practice Address - Country:US
Practice Address - Phone:516-256-6353
Practice Address - Fax:516-256-6347
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206947207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG17778Medicare UPIN