Provider Demographics
NPI:1154301927
Name:HEISMAN-RIFKIN, NICOLE J (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:HEISMAN-RIFKIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:J
Other - Last Name:HEISMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:305 SECOND AVE
Mailing Address - Street 2:MARKETPLACE AT COLLEGEVILLE
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2658
Mailing Address - Country:US
Mailing Address - Phone:484-961-8220
Mailing Address - Fax:484-961-8230
Practice Address - Street 1:555 GLASGOW ST
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:PA
Practice Address - Zip Code:19464-6557
Practice Address - Country:US
Practice Address - Phone:484-945-0770
Practice Address - Fax:484-945-0648
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H86722Medicare UPIN
070675Medicare ID - Type Unspecified
P00049998Medicare PIN