MEDICARE: ELLEN J. HEUMAN D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	035899	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295993319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEN J. HEUMAN D.D.S

Provider Business Mailing Address
First Line	:	PO BOX 260320
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-0320
Country	:	US
Telephone Number	:	718-856-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	865 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3105
Country	:	US
Telephone Number	:	718-856-9500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELLEN J. HEUMAN
Credential	:	D.D.S
Telephone Number	:	718-856-9500

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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