Healthcare Provider Details

I. General information

NPI: 1831965227
Provider Name (Legal Business Name): ISABEL HEPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 46TH AVE
LONG ISLAND CITY NY
11101-5245
US

IV. Provider business mailing address

242 GREENGROVE AVE
UNIONDALE NY
11553-1517
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-3700
  • Fax:
Mailing address:
  • Phone: 561-376-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: