1659393585 NPI number — FREDERICK W. HEGGAN, D.O. P.A.

Table of content: (NPI 1659393585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659393585 NPI number — FREDERICK W. HEGGAN, D.O. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERICK W. HEGGAN, D.O. P.A.
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:
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:
1659393585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3320 SIMPSON AVE
Provider Second Line Business Mailing Address:
TRADERS LANE
Provider Business Mailing Address City Name:
OCEAN CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08226-2044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-814-9550
Provider Business Mailing Address Fax Number:
609-814-9544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3320 SIMPSON AVE
Provider Second Line Business Practice Location Address:
TRADERS LANE
Provider Business Practice Location Address City Name:
OCEAN CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08226-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-814-9550
Provider Business Practice Location Address Fax Number:
609-814-9544
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEGGAN
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-814-9550

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MB02587100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0535261 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 379996 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0183776001 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7059108 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 16712 . This is a "UNIVERSITY HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 452052 . This is a "PENNSYLVANIA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080138059 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1078905 . This is a "HORIZON MERCY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P418240 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7059108 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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