Healthcare Provider Details

I. General information

NPI: 1386907053
Provider Name (Legal Business Name): HELAI HESHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST STE 16-22
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST STE 16-22
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-7333
  • Fax:
Mailing address:
  • Phone: 212-305-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT201299
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number299167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: