Provider Demographics
NPI:1811970387
Name:HELLER, PAUL J (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:HELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5214
Mailing Address - Country:US
Mailing Address - Phone:914-637-3510
Mailing Address - Fax:914-819-0061
Practice Address - Street 1:1312 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3121
Practice Address - Country:US
Practice Address - Phone:203-756-6422
Practice Address - Fax:203-756-2448
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024383207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01529322Medicaid
CTD77057Medicare UPIN
NY1179TZT5H1Medicare PIN
NY01529322Medicaid
CT050001568Medicare PIN
NY1179T1Medicare PIN
NY1179TYRXP1Medicare PIN