=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821480245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEIDI MARTIN HULLINGER MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2015
-----------------------------------------------------
Last Update Date | 02/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 OVERLOOK RD STE 305
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-376-1530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 OVERLOOK RD STE 305
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-376-1530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR/PHYSICIAN
-----------------------------------------------------
Name | HEIDI HULLINGER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 908-376-1530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0117X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
License Number | 25MA09508200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------