Healthcare Provider Details

I. General information

NPI: 1073395588
Provider Name (Legal Business Name): HEED PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 12/17/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 HARRINGTON AVE STE 9
CLOSTER NJ
07624-1911
US

IV. Provider business mailing address

100 W 131ST ST APT 3B
NEW YORK NY
10027-2353
US

V. Phone/Fax

Practice location:
  • Phone: 312-919-4122
  • Fax:
Mailing address:
  • Phone: 312-919-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: HASNAIN AFZAL
Title or Position: SOLE MEMBER
Credential: MD
Phone: 201-500-5505