| Organization Name: | HERITAGE MEDICAL ASSOCIATES PC |
| NPI Number: | 1003982547 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN PETER MISKOVSKY (PRESIDENT) |
| Mailing Address: | 131 Beechwood Ave Pawtucket |
| State: | RI US |
| Postal Code: | 028605409 |
| Phone Number: | 4014751999 |
| Fax Number: | 4014756932 |
| NPI Enumeration Date: | 11/27/2006 |
| NPI Last Update Date: | 10/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | CT 0816 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |