Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 116892 | NY |
NPI | 1043383789 |
---|---|
Provider Name | Elliot A Heller |
First Address | Pomona, NY 10970-3520 |
Second Address | Pomona, NY 10970-3520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00272486 | (05) | NY |
B79799 | (02) | NY |