Provider Demographics
NPI:1043530843
Name:HELLER, LAWRENCE ELLIOTT (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ELLIOTT
Last Name:HELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 EAST END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-722-0633
Mailing Address - Fax:212-722-0633
Practice Address - Street 1:180 EAST END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-722-0633
Practice Address - Fax:212-722-0633
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51053208800000X
NY119477208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology