Healthcare Provider Details

I. General information

NPI: 1245144005
Provider Name (Legal Business Name): ANDRE HENG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 W RITNER ST
PHILADELPHIA PA
19148-3949
US

IV. Provider business mailing address

536 W RITNER ST
PHILADELPHIA PA
19148-3949
US

V. Phone/Fax

Practice location:
  • Phone: 215-327-9293
  • Fax:
Mailing address:
  • Phone: 215-327-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number47652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: