Healthcare Provider Details

I. General information

NPI: 1407820053
Provider Name (Legal Business Name): MR. CLIFF HEYMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600C N WELLWOOD AVE
LINDENHURST NY
11757-2001
US

IV. Provider business mailing address

600C N WELLWOOD AVE
LINDENHURST NY
11757-2001
US

V. Phone/Fax

Practice location:
  • Phone: 631-957-0033
  • Fax: 631-957-2315
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number004417
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: