1861566119 NPI number — DR. ISSAM AFIF HALABY M.D.,PH.D.

Table of content: DR. ISSAM AFIF HALABY M.D.,PH.D. (NPI 1861566119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861566119 NPI number — DR. ISSAM AFIF HALABY M.D.,PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALABY
Provider First Name:
ISSAM
Provider Middle Name:
AFIF
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861566119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
436 NOKOMIS AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34285-2617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-445-5054
Provider Business Mailing Address Fax Number:
941-303-6796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
436 NOKOMIS AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34285-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-445-5054
Provider Business Practice Location Address Fax Number:
941-303-6796
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME83954 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12604 . This is a "UNIVERSAL HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2419854 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 08597 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 303424 . This is a "UNITED HEALTH CARE MPIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59-1362995 . This is a "GROUP TAX ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00778 . This is a "BLUE CROSS BLUE SHIELD GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00303804 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000191200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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