Healthcare Provider Details

I. General information

NPI: 1225536436
Provider Name (Legal Business Name): HEIDI OCNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEIDI BROOKE GERBER MSLAC, LMT

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 82ND ST APT 5G
JACKSON HEIGHTS NY
11372-5134
US

IV. Provider business mailing address

3540 82ND ST APT 5G
JACKSON HEIGHTS NY
11372-5134
US

V. Phone/Fax

Practice location:
  • Phone: 917-494-6679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number012970-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004474
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: