Basic Information
Provider Information | |||||||||
NPI: | 1720285455 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DE BEAUFORT | ||||||||
FirstName: | HEATHER | ||||||||
MiddleName: | CHRISTINE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BECK | ||||||||
OtherFirstName: | HEATHER | ||||||||
OtherMiddleName: | CHRISTINE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 450 E 63RD ST | ||||||||
Address2: | APT. 9-M | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100657928 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2022587269 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 423 E 23RD ST | ||||||||
Address2: |   | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100105011 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2126867500 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/27/2007 | ||||||||
LastUpdateDate: | 10/06/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 246663 | NY | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
No ID Information.