Provider Demographics
NPI:1356560965
Name:KIERNAN, HEIDI L (LAC)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:L
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DARON LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1013
Mailing Address - Country:US
Mailing Address - Phone:631-858-2888
Mailing Address - Fax:
Practice Address - Street 1:100 HICKSVILLE RD MASSAPEQUA WELLNESS CENTER
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-799-5407
Practice Address - Fax:516-799-5452
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001315171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist