Basic Information
| Provider Information | |||||||||
| NPI: | 1659393585 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FREDERICK W. HEGGAN, D.O. P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3320 SIMPSON AVE | ||||||||
| Address2: | TRADERS LANE | ||||||||
| City: | OCEAN CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082262044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098149550 | ||||||||
| FaxNumber: | 6098149544 | ||||||||
| Practice Location | |||||||||
| Address1: | 3320 SIMPSON AVE | ||||||||
| Address2: | TRADERS LANE | ||||||||
| City: | OCEAN CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082262044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098149550 | ||||||||
| FaxNumber: | 6098149544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 07/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | HEGGAN | ||||||||
| AuthorizedOfficialFirstName: | FREDERICK | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6098149550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB02587100 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0535261 | 01 | NJ | AETNA US HEALTHCARE | OTHER | 379996 | 01 | NJ | KEYSTONE HEALTH PLAN EAST | OTHER | 0183776001 | 01 | NJ | AMERIHEALTH | OTHER | 7059108 | 01 | NJ | AMERIGROUP | OTHER | 16712 | 01 | NJ | UNIVERSITY HEALTH PLANS | OTHER | 452052 | 01 | PA | PENNSYLVANIA BLUE SHIELD | OTHER | 080138059 | 01 | NJ | RAILROAD MEDICARE | OTHER | 1078905 | 01 | NJ | HORIZON MERCY HEALTH PLAN | OTHER | P418240 | 01 | NJ | OXFORD | OTHER | 7059108 | 05 | NJ | MEDICAID |