Provider Demographics
NPI:1699712968
Name:HEEBNER, JEFFREY A
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:HEEBNER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:A
Other - Last Name:HEEBNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:103 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1712
Mailing Address - Country:US
Mailing Address - Phone:610-828-6990
Mailing Address - Fax:610-828-7364
Practice Address - Street 1:103 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1712
Practice Address - Country:US
Practice Address - Phone:610-828-6990
Practice Address - Fax:610-828-7364
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009112L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA64664OtherAOA NUMBER
PANI64620Medicare PIN
PAG91895Medicare UPIN