Provider Demographics
NPI:1336168954
Name:HEUBLUM, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HEUBLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:247 3RD AVE
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7457
Mailing Address - Country:US
Mailing Address - Phone:212-505-9800
Mailing Address - Fax:212-614-0290
Practice Address - Street 1:247 3RD AVE
Practice Address - Street 2:SUITE # 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7457
Practice Address - Country:US
Practice Address - Phone:212-505-9800
Practice Address - Fax:212-614-0290
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1715032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology