1578657375 NPI number — HEFFERNAN ASSALEY & LEE M D INC.

Table of content: DR. MARK ADAM BUCHSBAUM M.D. (NPI 1932359072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578657375 NPI number — HEFFERNAN ASSALEY & LEE M D INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEFFERNAN ASSALEY & LEE M D INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1578657375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 12TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-3833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-522-3420
Provider Business Mailing Address Fax Number:
304-529-4645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-3833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-3420
Provider Business Practice Location Address Fax Number:
304-529-4645
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMSON
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
MEDICAL ASSISTANT
Authorized Official Telephone Number:
304-522-3420

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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