Healthcare Provider Details

I. General information

NPI: 1730133562
Provider Name (Legal Business Name): HEIGHTS MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 BOULEVARD
HASBROUCK HEIGHTS NJ
07604-1315
US

IV. Provider business mailing address

288 BOULEVARD
HASBROUCK HEIGHTS NJ
07604-1315
US

V. Phone/Fax

Practice location:
  • Phone: 201-288-6781
  • Fax: 201-288-2734
Mailing address:
  • Phone: 201-288-6781
  • Fax: 201-288-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39369
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21636
License Number StateNJ

VIII. Authorized Official

Name: MS. ELLEN V SCHAFFER
Title or Position: ADMIN
Credential:
Phone: 201-288-6364