Healthcare Provider Details

I. General information

NPI: 1346376696
Provider Name (Legal Business Name): NOAH SOLOMON HEFTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 58TH ST 4TH FLOOR ANNEX
NEW YORK NY
10155-0002
US

IV. Provider business mailing address

150 E 58TH ST 4TH FLOOR ANNEX
NEW YORK NY
10155-0002
US

V. Phone/Fax

Practice location:
  • Phone: 212-583-2966
  • Fax:
Mailing address:
  • Phone: 212-583-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number184994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: