Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MT219716 | PA |
NPI | 1700270683 |
---|---|
Provider Name | Dr. Jessica Heidenberg Heyer |
First Address | New York, NY 10087-9234 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 27/01/2022 |