Basic Information
| Provider Information | |||||||||
| NPI: | 1497861678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEINLEIN | ||||||||
| FirstName: | DARA | ||||||||
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| Credential: | NPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 GREEN STREET | ||||||||
| Address2: | STE 2 | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453393736 | ||||||||
| FaxNumber: | 8453396731 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 MARY'S AVENUE | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453382500 | ||||||||
| FaxNumber: | 8453343172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 08/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | F4009681 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | F400968 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.