Provider Demographics
NPI:1124108337
Name:HEFFRON, BARRY DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:DAVID
Last Name:HEFFRON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N VILLAGE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3761
Mailing Address - Country:US
Mailing Address - Phone:516-764-2222
Mailing Address - Fax:516-764-7314
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-764-2222
Practice Address - Fax:516-764-7314
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006271-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBH0X419510Medicare ID - Type UnspecifiedPROVIDER ID
NYT96022Medicare UPIN