1962671909 NPI number — MR. JOSE M HEISECKE MD..

Table of content: MR. JOSE M HEISECKE MD.. (NPI 1962671909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962671909 NPI number — MR. JOSE M HEISECKE MD..

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEISECKE
Provider First Name:
JOSE
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD..
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:
1962671909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 NORTH ST STE 407
Provider Second Line Business Mailing Address:
PO BOX 1677
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-4172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-445-6420
Provider Business Mailing Address Fax Number:
413-499-4907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 NORTH ST STE 407
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-4172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-445-6420
Provider Business Practice Location Address Fax Number:
413-499-4907
Provider Enumeration Date:
02/25/2008

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: 207Q00000X , with the licence number:  231102 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 231102 , 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)