Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | MD440044 | PA |
N | 207RA0201X | Internist - Allergy & Immunology | 25MA07835700 | NJ |
N | 208000000X | Pediatrician | 25MA07835700 | NJ |
N | 208000000X | Pediatrician | MD440044 | PA |
Y | 2080P0201X | Pediatric Allergist | MD440044 | PA |
NPI | 1104023316 |
---|---|
Provider Name | Dr. Jennifer Rebecca Heimall |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-3365 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 15/04/2013 |