Provider Demographics
NPI:1215751276
Name:HERITAGE NEW YORK, IPA
Entity type:Organization
Organization Name:HERITAGE NEW YORK, IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ICARANGAL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:516-515-8825
Mailing Address - Street 1:501 FRANKLIN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5807
Mailing Address - Country:US
Mailing Address - Phone:516-746-2200
Mailing Address - Fax:
Practice Address - Street 1:501 FRANKLIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5807
Practice Address - Country:US
Practice Address - Phone:516-746-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty