Provider Demographics
NPI:1730435330
Name:HEIMENRATH, MAUREEN GISSELL (MS)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:GISSELL
Last Name:HEIMENRATH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 STONE RD
Mailing Address - Street 2:
Mailing Address - City:UNION BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-2726
Mailing Address - Country:US
Mailing Address - Phone:732-217-1570
Mailing Address - Fax:
Practice Address - Street 1:403 STONE RD
Practice Address - Street 2:
Practice Address - City:UNION BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07735-2726
Practice Address - Country:US
Practice Address - Phone:732-217-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY581654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist