Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD428905 | MI |
Y | 208600000X | Surgeon | MD428905 | MI |
N | 2086S0120X | Pediatric Surgery | MD428905 | PA |
NPI | 1568656957 |
---|---|
Provider Name | Todd Heaton |
First Address | New York, NY 10065-6007 |
Second Address | New York, NY 10065-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 16/03/2021 |