Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 25MA04455400 | NJ |
Y | 208200000X | Surgeon | 158614-1 | NY |
Y | 208600000X | Surgeon | 158614-1 | NY |
NPI | 1770688723 |
---|---|
Provider Name | Dr. Elliot Heller |
First Address | Edison, NJ 08837-2500 |
Second Address | Edison, NJ 08837-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 19/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E23762 | (02) | NJ |