Healthcare Provider Details

I. General information

NPI: 1225450778
Provider Name (Legal Business Name): TINA MARIE HEIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA MARIE HOROWITZ RN

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 CLEARWATER RD PO BX 318
HIGHLAND NY
12528-1110
US

IV. Provider business mailing address

62 CLEARWATER RD PO BX 318
HIGHLAND NY
12528-1110
US

V. Phone/Fax

Practice location:
  • Phone: 845-522-9538
  • Fax:
Mailing address:
  • Phone: 845-522-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number674486-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: