Healthcare Provider Details

I. General information

NPI: 1780989319
Provider Name (Legal Business Name): TAMAR HEISLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number261521
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: