Provider Demographics
NPI:1558104943
Name:HEFFERNAN, MOIRA
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOIRA
Other - Middle Name:
Other - Last Name:SAPIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3769 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2041
Mailing Address - Country:US
Mailing Address - Phone:718-769-9888
Mailing Address - Fax:
Practice Address - Street 1:3769 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2041
Practice Address - Country:US
Practice Address - Phone:718-769-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1816096241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist