Healthcare Provider Details

I. General information

NPI: 1518193770
Provider Name (Legal Business Name): HEATHER HURD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD SUITE 115
GREAT NECK NY
11021-5200
US

IV. Provider business mailing address

600 NORTHERN BLVD SUITE 115
GREAT NECK NY
11021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-8220
  • Fax: 516-482-8221
Mailing address:
  • Phone: 516-482-8220
  • Fax: 516-482-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberP68812
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: