Provider Demographics
NPI:1861487035
Name:HELLER, JOY L (DO)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:L
Last Name:HELLER
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 1:412 CREAMERY WAY
Mailing Address - Street 2:STE 400
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2551
Mailing Address - Country:US
Mailing Address - Phone:610-594-7590
Mailing Address - Fax:610-594-7597
Practice Address - Street 1:4667 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2227
Practice Address - Country:US
Practice Address - Phone:610-356-7870
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007500L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA501624NB6OtherMEDICARE ID-TYPE UNSPECIFIED
PA0016190190005Medicaid
PA501624STZMedicare PIN
PAF71263Medicare UPIN
PA0016190190005Medicaid