| Doctor Name: | MR. NEIL CULLEN HEFFERNAN |
| NPI Number: | 1790709871 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | MA001791L |
| Business Practice Address: | 1111 Eastend Blvd Wilkes-barre, PA - 18711 |
| Business Phone Number: | 5708243521 |
| Business Fax Number: | |
| Mailing Address: | 30 Farmhouse Rd, MOUNTAIN TOP |
| State: | PA |
| Postal Code: | 187071725 |
| Phone Number: | 5704746249 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | MA001791L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |