Healthcare Provider Details

I. General information

NPI: 1528193356
Provider Name (Legal Business Name): ANN HEFFERON KILCARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MARCUS AVE STE M15
NORTH NEW HYDE PARK NY
11042-1023
US

IV. Provider business mailing address

158 ASPEN ST
FLORAL PARK NY
11001-3432
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-8808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015546-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: