Healthcare Provider Details

I. General information

NPI: 1417435173
Provider Name (Legal Business Name): ELISEBETH J HEILIG MS ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 RED MILLS RD
PINE BUSH NY
12566-6213
US

IV. Provider business mailing address

PO BOX 4562
MIDDLETOWN NY
10941-8562
US

V. Phone/Fax

Practice location:
  • Phone: 845-978-9569
  • Fax:
Mailing address:
  • Phone: 845-978-9569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: