Provider Demographics
NPI:1548854581
Name:HEATH, AMBER (DAT, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:DAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOFFMAN BLVD APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1555
Mailing Address - Country:US
Mailing Address - Phone:757-618-1113
Mailing Address - Fax:
Practice Address - Street 1:303 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1798
Practice Address - Country:US
Practice Address - Phone:975-877-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0030962255A2300X
NJ25MT002347002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBOL0000182OtherBOLINGER