Basic Information
| Provider Information | |||||||||
| NPI: | 1639155179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HELLER | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1559 SULLIVAN AVE | ||||||||
| Address2: | HARTFORD MEDICAL GROUP | ||||||||
| City: | SOUTH WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060742712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606962350 | ||||||||
| FaxNumber: | 8606962360 | ||||||||
| Practice Location | |||||||||
| Address1: | 1559 SULLIVAN AVE | ||||||||
| Address2: | HARTFORD MEDICAL GROUP | ||||||||
| City: | SOUTH WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060742712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606962350 | ||||||||
| FaxNumber: | 8606962360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 10/29/2012 | ||||||||
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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 | 207R00000X | 030644 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001306449 | 05 | CT | MEDICAID |