Provider Demographics
NPI:1447676143
Name:HEICHMAN, ROBERTA
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:HEICHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 SEAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3233
Mailing Address - Country:US
Mailing Address - Phone:516-509-4653
Mailing Address - Fax:
Practice Address - Street 1:158 SEAMAN AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3233
Practice Address - Country:US
Practice Address - Phone:516-509-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency