Healthcare Provider Details

I. General information

NPI: 1164558292
Provider Name (Legal Business Name): CATHLEEN CLARE HEFFERNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

208 E 28TH ST APT 4L
NEW YORK NY
10016-8568
US

V. Phone/Fax

Practice location:
  • Phone: 212-731-5353
  • Fax:
Mailing address:
  • Phone: 212-252-7858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number227592-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: