Provider Demographics
NPI:1043533615
Name:HERITAGE NEUROLOGICAL, P.C.
Entity type:Organization
Organization Name:HERITAGE NEUROLOGICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORJUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-992-3412
Mailing Address - Street 1:1225 FRANKLIN AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1691
Mailing Address - Country:US
Mailing Address - Phone:516-992-3412
Mailing Address - Fax:
Practice Address - Street 1:8416 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1920
Practice Address - Country:US
Practice Address - Phone:718-296-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty