Provider Demographics
NPI:1548294663
Name:HELLER, JON IAN
Entity type:Individual
Prefix:
First Name:JON
Middle Name:IAN
Last Name:HELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2561
Mailing Address - Country:US
Mailing Address - Phone:973-389-9000
Mailing Address - Fax:973-389-9011
Practice Address - Street 1:384 UNION BLVD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2561
Practice Address - Country:US
Practice Address - Phone:973-389-9000
Practice Address - Fax:973-389-9011
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02274213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7637306Medicaid
NJ1253540001Medicare NSC
NJ51304Medicare UPIN
NJHE527270Medicare PIN