Provider Demographics
NPI:1902998685
Name:HEIFLER, GREGORY D (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:HEIFLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PARK STREET
Mailing Address - Street 2:BUILDING B
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042
Mailing Address - Country:US
Mailing Address - Phone:973-783-4117
Mailing Address - Fax:973-783-5236
Practice Address - Street 1:103 PARK STREET
Practice Address - Street 2:BUILDING B
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-783-4117
Practice Address - Fax:973-783-5236
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064696NJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ719298OtherRAIL ROAD MEDICARE
G44235Medicare UPIN
NJHE719298Medicare ID - Type Unspecified