Healthcare Provider Details

I. General information

NPI: 1073954350
Provider Name (Legal Business Name): JAMES F HEUBERGER RNC,BSN,MPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 TWIN BROOKS DR
CHESTER NY
10918-2631
US

IV. Provider business mailing address

18 TWIN BROOKS DR
CHESTER NY
10918-2631
US

V. Phone/Fax

Practice location:
  • Phone: 845-782-6310
  • Fax:
Mailing address:
  • Phone: 845-782-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number314375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: