Healthcare Provider Details

I. General information

NPI: 1629153036
Provider Name (Legal Business Name): MARK STEVEN HEFFRON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 211TH ST
QUEENS VILLAGE NY
11427-1012
US

IV. Provider business mailing address

8003 211TH ST
QUEENS VILLAGE NY
11427-1012
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-8948
  • Fax: 718-740-0319
Mailing address:
  • Phone: 718-464-8948
  • Fax: 718-740-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberX002652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: