Provider Demographics
NPI:1174117907
Name:HEYTAK, ABLAJAN (PA)
Entity type:Individual
Prefix:
First Name:ABLAJAN
Middle Name:
Last Name:HEYTAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2625
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8925
Mailing Address - Country:US
Mailing Address - Phone:718-321-8246
Mailing Address - Fax:718-321-8273
Practice Address - Street 1:13640 39TH AVE STE 6GB
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5536
Practice Address - Country:US
Practice Address - Phone:718-321-8246
Practice Address - Fax:718-321-8273
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61260172363A00000X
NY026512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant