Provider Demographics
NPI:1801355201
Name:HEINLEIN, JOSEPH JOHN III
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:HEINLEIN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 CENTRAL PARK AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1034
Mailing Address - Country:US
Mailing Address - Phone:914-479-5200
Mailing Address - Fax:914-479-5206
Practice Address - Street 1:455 CENTRAL PARK AVE STE 314
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1034
Practice Address - Country:US
Practice Address - Phone:914-479-5200
Practice Address - Fax:914-479-5206
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2183L001374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide