Healthcare Provider Details

I. General information

NPI: 1073477410
Provider Name (Legal Business Name): MRS. JESSICA NICOLE HEEGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MILLDOWN RD
YAPHANK NY
11980-9770
US

IV. Provider business mailing address

23 MILLDOWN RD
YAPHANK NY
11980-9770
US

V. Phone/Fax

Practice location:
  • Phone: 631-332-8447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: