NPI | 1700270683 |
---|---|
Former Name | JESSICA ERIN HEIDENBERG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NY 308905) |
Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: PA MT219716) |
Enumeration Date | 2015-03-27 |
Last Update Date | 2022-10-12 |