Provider Demographics
NPI:1114547791
Name:HEIN, MICHELE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DEMAREST RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1404
Mailing Address - Country:US
Mailing Address - Phone:516-220-7911
Mailing Address - Fax:
Practice Address - Street 1:700 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2952
Practice Address - Country:US
Practice Address - Phone:516-220-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00266700363AM0700X
NY006711363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical