Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 041288 | CT |
NPI | 1033119813 |
---|---|
Provider Name | Asefeh Heiat |
First Address | New Haven, CT 06511-1336 |
Second Address | New Haven, CT 06511-1336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 25/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001412882 | (05) | CT |
I02740 | (02) |