Basic Information
| Provider Information | |||||||||
| NPI: | 1154301927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEISMAN-RIFKIN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HEISMAN | ||||||||
| OtherFirstName: | NICOLE | ||||||||
| OtherMiddleName: | J | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 305 SECOND AVE | ||||||||
| Address2: | MARKETPLACE AT COLLEGEVILLE | ||||||||
| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194262658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4849618220 | ||||||||
| FaxNumber: | 4849618230 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 GLASGOW ST | ||||||||
| Address2: | |||||||||
| City: | STOWE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194646557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4849450770 | ||||||||
| FaxNumber: | 4849450648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS012032 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.