Provider Demographics
NPI:1528274602
Name:DR RONALD S.HECKER
Entity type:Organization
Organization Name:DR RONALD S.HECKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-236-7005
Mailing Address - Street 1:2160 81ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2508
Mailing Address - Country:US
Mailing Address - Phone:718-236-7005
Mailing Address - Fax:718-236-7118
Practice Address - Street 1:2160 81ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2508
Practice Address - Country:US
Practice Address - Phone:718-236-7005
Practice Address - Fax:718-236-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33251261QD0000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00326265Medicaid