Healthcare Provider Details

I. General information

NPI: 1114236494
Provider Name (Legal Business Name): MR. ALFRED HEYWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 LINDA AVE
HAWTHORNE NY
10532-2018
US

IV. Provider business mailing address

279 W 117TH ST
NEW YORK NY
10026-2109
US

V. Phone/Fax

Practice location:
  • Phone: 914-773-7314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: