Healthcare Provider Details

I. General information

NPI: 1124108337
Provider Name (Legal Business Name): BARRY DAVID HEFFRON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE SUITE 4
ROCKVILLE CENTRE NY
11570-3761
US

IV. Provider business mailing address

165 N VILLAGE AVE SUITE 4
ROCKVILLE CENTRE NY
11570-3761
US

V. Phone/Fax

Practice location:
  • Phone: 516-764-2222
  • Fax: 516-764-7314
Mailing address:
  • Phone: 516-764-2222
  • Fax: 516-764-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX006271-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: