Provider Demographics
NPI:1154335776
Name:HEISE, CARL W (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:W
Last Name:HEISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:420 E 72ND ST
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4650
Mailing Address - Country:US
Mailing Address - Phone:212-988-4815
Mailing Address - Fax:212-955-1122
Practice Address - Street 1:420 E 72ND ST
Practice Address - Street 2:SUITE 1J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4650
Practice Address - Country:US
Practice Address - Phone:212-988-4815
Practice Address - Fax:212-955-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185547174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist