Basic Information
| Provider Information | |||||||||
| NPI: | 1174551287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'DONNELL | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1621 EASTCHESTER RD STE 102 | ||||||||
| Address2: | AECOM, CHILDREN'S HOSPITAL AT MONTEFIORE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184058040 | ||||||||
| FaxNumber: | 7184058091 | ||||||||
| Practice Location | |||||||||
| Address1: | 1621 EASTCHESTER RD STE 102 | ||||||||
| Address2: | AECOM, CHILDREN'S HOSPITAL AT MONTEFIORE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184058040 | ||||||||
| FaxNumber: | 7184058091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | 235466 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | 208000000X | 235466 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.