Provider Demographics
NPI:1477725208
Name:HEART AND HEALTH PLLC
Entity type:Organization
Organization Name:HEART AND HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVESTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-482-1355
Mailing Address - Street 1:1350 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1619
Mailing Address - Country:US
Mailing Address - Phone:631-482-1355
Mailing Address - Fax:631-482-1356
Practice Address - Street 1:1350 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1619
Practice Address - Country:US
Practice Address - Phone:631-482-1355
Practice Address - Fax:631-482-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215374174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02130743Medicaid
NY02130743Medicaid