Provider Demographics
NPI:1669547394
Name:HELLER, MAX (DC)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:HELLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MADISON AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6306
Mailing Address - Country:US
Mailing Address - Phone:212-725-0575
Mailing Address - Fax:212-725-0577
Practice Address - Street 1:290 MADISON AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6306
Practice Address - Country:US
Practice Address - Phone:212-725-0575
Practice Address - Fax:212-725-0577
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300010706OtherMEDICARE QUEENS
NYC10560-3BOtherWORKERS COMPENSATION
NY9300000980Medicare PIN