Provider Demographics
NPI:1386739431
Name:HELLER, MARC (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:HELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12307-1508
Mailing Address - Country:US
Mailing Address - Phone:518-374-5353
Mailing Address - Fax:518-377-2517
Practice Address - Street 1:1040 STATE STREET
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12307-1508
Practice Address - Country:US
Practice Address - Phone:518-374-5353
Practice Address - Fax:518-377-2517
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122543-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010122543OtherEXCELLUS BLUE CROSS
NY0016349OtherGHI
NY156881OtherMVP HEALTH PLAN
NY06000122543Medicaid
NY10032170OtherCDPHP
NYMH0467C710OtherEMPIRE BLUE CROSS
NY004711832OtherBLUE SHIELD NORTHEASTERN
NY004711832OtherBLUE SHIELD NORTHEASTERN
NY10032170OtherCDPHP