Healthcare Provider Details

I. General information

NPI: 1194612333
Provider Name (Legal Business Name): JUDITH C HEFFERNAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 STRATFORD RD
SOUTH HEMPSTEAD NY
11550-8015
US

IV. Provider business mailing address

492 STRATFORD RD
SOUTH HEMPSTEAD NY
11550-8015
US

V. Phone/Fax

Practice location:
  • Phone: 516-318-2735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number563188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: