Healthcare Provider Details

I. General information

NPI: 1659372688
Provider Name (Legal Business Name): JOHN F. HEITNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 PLAZA ST W
BROOKLYN NY
11217-3905
US

IV. Provider business mailing address

506 6TH ST CARDIOLOGY - 2ND FLOOR
BROOKLYN NY
11215-3609
US

V. Phone/Fax

Practice location:
  • Phone: 718-789-4322
  • Fax:
Mailing address:
  • Phone: 718-780-5037
  • Fax: 718-780-7717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number232536
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number232536
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: