Provider Demographics
NPI:1184077653
Name:HERITAGE, ELLA L (LMT)
Entity type:Individual
Prefix:MRS
First Name:ELLA
Middle Name:L
Last Name:HERITAGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BRIDGETON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1218
Mailing Address - Country:US
Mailing Address - Phone:609-557-7041
Mailing Address - Fax:
Practice Address - Street 1:7 BRIDGETON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1218
Practice Address - Country:US
Practice Address - Phone:609-557-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist