Healthcare Provider Details

I. General information

NPI: 1962465617
Provider Name (Legal Business Name): ERIC SCOTT HEFFELFINGER D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARTOL AVE STE 14
RIDLEY PARK PA
19078-2214
US

IV. Provider business mailing address

1 BARTOL AVE STE 14
RIDLEY PARK PA
19078-2214
US

V. Phone/Fax

Practice location:
  • Phone: 610-521-1300
  • Fax: 610-521-9074
Mailing address:
  • Phone: 610-521-1300
  • Fax: 610-521-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS-005764L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: