Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 303130 | NY |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 303130 | NY |
NPI | 1053798900 |
---|---|
Provider Name | Dr. Henry Heaton |
First Address | New York, NY 10012-1354 |
Second Address | New York, NY 10012-1354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2015 |
Last Update Date | 14/07/2020 |