Provider Demographics
NPI:1457547275
Name:FRANK-GOFFE, HEATHER A (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:A
Last Name:FRANK-GOFFE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:78 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1218
Mailing Address - Country:US
Mailing Address - Phone:917-846-6960
Mailing Address - Fax:
Practice Address - Street 1:78 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1218
Practice Address - Country:US
Practice Address - Phone:917-846-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-16
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00518100111NS0005X
NYX008558-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX93611Medicare PIN