# HEIDI FYRBERG PHYSICIAN ASSISTANT PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770054710
- **Authorized official:** HEIDI FYRBERG-COHEN PA (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (516) 652-7100

## Contact information

- **Practice address:** 1895 WALT WHITMAN RD, MELVILLE, NY 11747-3031
- **Practice address phone:** (516) 652-7100
- **Mailing address:** 20 DONOVAN DR, COLD SPRING HARBOR, NY 11724-2222
- **Mailing address phone:** (516) 652-7100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 12/17/2018
- **Last updated:** 12/17/2018