Provider Demographics
NPI:1245285121
Name:GARY X. HECK & RONALD L. SCHIAVONE, LLC
Entity type:Organization
Organization Name:GARY X. HECK & RONALD L. SCHIAVONE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-751-6403
Mailing Address - Street 1:222 GIBBSBORO RD
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4132
Mailing Address - Country:US
Mailing Address - Phone:856-784-4999
Mailing Address - Fax:856-784-0258
Practice Address - Street 1:222 GIBBSBORO RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4132
Practice Address - Country:US
Practice Address - Phone:856-784-4999
Practice Address - Fax:856-784-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000458806OtherHIGHMARK BLUE SHIELD ID
NJ0121648002OtherAMERIHEALTH HMO -OFFICE 2
NJ0121648001OtherHMO AMERIHEALTH
NJ3533107Medicaid
NJ0121648002OtherAMERIHEALTH HMO -OFFICE 2