Healthcare Provider Details

I. General information

NPI: 1902169881
Provider Name (Legal Business Name): DONNA J HEUSKIN MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2012
Last Update Date: 06/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 GRANT ST
FARMINGDALE NY
11735-6720
US

IV. Provider business mailing address

53 GRANT ST
FARMINGDALE NY
11735-6720
US

V. Phone/Fax

Practice location:
  • Phone: 516-293-5110
  • Fax:
Mailing address:
  • Phone: 516-293-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1308483
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: