Provider Demographics
NPI:1477862324
Name:HELLER DERMATOLOGY CENTER PA
Entity type:Organization
Organization Name:HELLER DERMATOLOGY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:386-239-8700
Mailing Address - Street 1:511 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2323
Mailing Address - Country:US
Mailing Address - Phone:386-239-8700
Mailing Address - Fax:386-239-7070
Practice Address - Street 1:511 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2323
Practice Address - Country:US
Practice Address - Phone:386-239-8700
Practice Address - Fax:386-239-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6226207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80659OtherBCBS OF FL
FL80659OtherBCBS OF FL