Healthcare Provider Details

I. General information

NPI: 1497716252
Provider Name (Legal Business Name): ALBERT HEUSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 GARDEN STREET
GARDEN CITY NY
11530
US

IV. Provider business mailing address

81 GARDEN STREET
GARDEN CITY NY
11530
US

V. Phone/Fax

Practice location:
  • Phone: 516-263-0125
  • Fax:
Mailing address:
  • Phone: 516-263-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number174089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: