Provider Demographics
NPI:1861453011
Name:HEILBRONER, PETER (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:HEILBRONER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EAST RIDGEWOOD AVE
Mailing Address - Street 2:EAST WING - 2ND FLOOR
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-444-0868
Mailing Address - Fax:201-493-0797
Practice Address - Street 1:1200 EAST RIDGEWOOD AVE
Practice Address - Street 2:EAST WING - 2ND FLOOR
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-444-0868
Practice Address - Fax:201-493-0797
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA669932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7707100Medicaid
NJ7707100Medicaid
017933ADPMedicare PIN
G79862Medicare UPIN