Healthcare Provider Details

I. General information

NPI: 1487755732
Provider Name (Legal Business Name): DR. JASON HECKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MANNING BLVD SUITE 304
ALBANY NY
12208-1742
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-5207
  • Fax: 518-525-5209
Mailing address:
  • Phone: 518-525-5634
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number240240
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: