Provider Demographics
NPI:1750552907
Name:HECKER DERMATOLOGY GROUP P.A.
Entity type:Organization
Organization Name:HECKER DERMATOLOGY GROUP P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:SCHWARTZ
Authorized Official - Last Name:HECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:954-783-2323
Mailing Address - Street 1:3500 NE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-783-2323
Mailing Address - Fax:954-783-2321
Practice Address - Street 1:3500 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4445
Practice Address - Country:US
Practice Address - Phone:954-783-2323
Practice Address - Fax:954-783-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2357AOtherPTAN