Cameron Hetzler

Primary specialty

DentistTaxonomy code 122300000X

License

059465 Issued in NY

Practice address

645 10TH Ave
New York, NY 10036-2904

Phone

(212) 749-1820

NPI assigned

Jul 27, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Keefe Anthony Hetzler Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ryan-Chelsea Clinton Community Health Center

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1215978960
  Medicare reassignment NPD
• The Children's Aid Society

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bronx, NY
  • NPI 1730124025
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1518410471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100362904",
            "telephone_number": "212-749-1820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100362904",
            "telephone_number": "212-749-1820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "374 Stockholm St.",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11237",
            "country_code": "US",
            "telephone_number": "718-963-7174",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 W. Palisades Blvd.",
            "address_2": "Apt. C-1-1",
            "address_purpose": "LOCATION",
            "city": "Palisades Park",
            "state": "NJ",
            "postal_code": "07650",
            "country_code": "US",
            "telephone_number": "732-861-2414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HETZLER",
        "first_name": "CAMERON",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-27",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "059465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEEFE",
            "last_name": "HETZLER",
            "middle_name": "ANTHONY",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Roy Hester
• Allison Lene Hesterman, LMSW
• Meaghan Johnson Hetherington
• Bethany Hetrick
• Kira Hettler, PA-C
• Theresa Hetzler, MD
• Michael Heublum, M.D.
• Heuer Optical
• Heuer Optical
• Heuer Optical

• Dentist in New York, NY
• Providers in New York, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.