Healthcare Provider Details

I. General information

NPI: 1881472959
Provider Name (Legal Business Name): JANE HEGLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E LAKE DR
MONTAUK NY
11954-5221
US

IV. Provider business mailing address

161 E LAKE DR
MONTAUK NY
11954-5221
US

V. Phone/Fax

Practice location:
  • Phone: 917-734-4105
  • Fax:
Mailing address:
  • Phone: 917-734-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: