Provider Demographics
NPI:1306048301
Name:HESLOP, PAULINE B (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:B
Last Name:HESLOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4139 WICKHAM AVE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2039
Mailing Address - Country:US
Mailing Address - Phone:718-994-5931
Mailing Address - Fax:718-994-1957
Practice Address - Street 1:4139 WICKHAM AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2039
Practice Address - Country:US
Practice Address - Phone:718-994-5931
Practice Address - Fax:718-994-1957
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1482392080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00756932Medicaid