Healthcare Provider Details

I. General information

NPI: 1497212443
Provider Name (Legal Business Name): ALBERT WILLIAM HEUSER IV MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 GARDEN ST
GARDEN CITY NY
11530-6506
US

IV. Provider business mailing address

81 GARDEN ST
GARDEN CITY NY
11530-6506
US

V. Phone/Fax

Practice location:
  • Phone: 516-965-6684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1297124191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: