MEDICARE: DR. MICHAEL STEWART HEITLER MD

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	208000000X	Pediatrics Physician	084367	NY

General Provider Information

NPI Number	:	1770656589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL STEWART HEITLER MD

Provider Business Mailing Address
First Line	:	41 EAST MALL DRIVE
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-2321
Country	:	US
Telephone Number	:	631-367-3305
Fax Number	:	631-367-3113

Provider Business Practice Location Address
First Line	:	41 EAST MALL DRIVE
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-2321
Country	:	US
Telephone Number	:	631-367-3305
Fax Number	:	631-367-3113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	01/18/2026

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