Healthcare Provider Details

I. General information

NPI: 1093666497
Provider Name (Legal Business Name): JINA HEO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E BETHPAGE RD STE 200B
PLAINVIEW NY
11803-4224
US

IV. Provider business mailing address

42 FRANKLIN CT
GARDEN CITY NY
11530-6109
US

V. Phone/Fax

Practice location:
  • Phone: 866-776-6782
  • Fax: 631-454-4553
Mailing address:
  • Phone: 646-533-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043423
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: