Doctor Name: | DR. THOMAS EDWARD HEINZEN |
NPI Number: | 1073559951 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 68 012043 |
Business Practice Address: | 476 Christian Herald Rd Valley Cottage, NY - 109892230 |
Business Phone Number: | 8452686861 |
Business Fax Number: | |
Mailing Address: | 905 Bloomfield Ave, GLEN RIDGE |
State: | NJ |
Postal Code: | 070281329 |
Phone Number: | 9737480622 |
Fax Number: | |
NPI Enumeration Date: | 06/21/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 68 012043 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |