Provider Demographics
NPI:1699895672
Name:FYRBERG, HEIDI (PA-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:FYRBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:695 US HIGHWAY 46
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1592
Mailing Address - Country:US
Mailing Address - Phone:973-894-1263
Mailing Address - Fax:888-972-3703
Practice Address - Street 1:831 LITTLE BRITAIN RD
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5518
Practice Address - Country:US
Practice Address - Phone:845-446-1100
Practice Address - Fax:845-446-4581
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005916363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400118590OtherPTAN QSNY1
NYA400123912OtherMCARE PTAN QSNY2
NYA400123912OtherMCARE PTAN QSNY2