1235122417 NPI number — DR. LESLYE ROBIN HEILIG MD

Table of content: DR. LESLYE ROBIN HEILIG MD (NPI 1235122417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235122417 NPI number — DR. LESLYE ROBIN HEILIG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEILIG
Provider First Name:
LESLYE
Provider Middle Name:
ROBIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235122417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MAPLE AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT BARRINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01230-1965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-528-4047
Provider Business Mailing Address Fax Number:
413-528-3407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MAPLE AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT BARRINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01230-1965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-528-4047
Provider Business Practice Location Address Fax Number:
413-528-3407
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  073130 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26955 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3067432 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 817410 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P625198 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000020948 . This is a "BMC HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00979915 . This is a "NY MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10275301 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA0479 . This is a "HEALTHNET OF THE NE, INC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 073130 . This is a "CTCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10029273 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28100 . This is a "CHILDRENS MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12991 . This is a "HEALTH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 073130 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: A64448 . This is a "HARVARD PILGRIM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: J10138 . This is a "BCBS OF MA" identifier . This identifiers is of the category "OTHER".




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