Healthcare Provider Details

I. General information

NPI: 1639876600
Provider Name (Legal Business Name): ENSAGE VIRTUAL MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 5TH AVE
NEW YORK NY
10001-7708
US

IV. Provider business mailing address

220 5TH AVE
NEW YORK NY
10001-7708
US

V. Phone/Fax

Practice location:
  • Phone: 206-716-5719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY TODD HECKMAN
Title or Position: PC OWNER
Credential: MD
Phone: 206-716-5719