Healthcare Provider Details

I. General information

NPI: 1215082946
Provider Name (Legal Business Name): ELLEN J. HEUMAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 PARK AVE
NEW YORK NY
10021
US

IV. Provider business mailing address

1175 PARK AVE APARTMENT 5A-1
NEW YORK NY
10128-1211
US

V. Phone/Fax

Practice location:
  • Phone: 212-327-0576
  • Fax: 212-737-0696
Mailing address:
  • Phone: 212-423-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number035899
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: