Healthcare Provider Details

I. General information

NPI: 1255571840
Provider Name (Legal Business Name): AMY ELIZA HERON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 53RD ST #707
NEW YORK NY
10019-5622
US

IV. Provider business mailing address

410 W 53RD ST #707
NEW YORK NY
10019-5622
US

V. Phone/Fax

Practice location:
  • Phone: 212-333-5663
  • Fax: 212-333-5663
Mailing address:
  • Phone: 212-333-5663
  • Fax: 212-333-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number023833-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: