1669595617 NPI number — MR. JOHN H HECKLER PHD

Table of content: MR. JOHN H HECKLER PHD (NPI 1669595617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669595617 NPI number — MR. JOHN H HECKLER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HECKLER
Provider First Name:
JOHN
Provider Middle Name:
H
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

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:
1669595617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 687
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEWKSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-851-4251
Provider Business Mailing Address Fax Number:
978-851-8515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1445 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
TEWKSBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-851-4251
Provider Business Practice Location Address Fax Number:
978-851-8515
Provider Enumeration Date:
04/06/2007

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: 103TC0700X , with the licence number:  2483 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 1000 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 6616 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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