1063408805 NPI number — DR. SALLY HALIM O.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063408805 NPI number — DR. SALLY HALIM O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALIM
Provider First Name:
SALLY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1063408805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 CENTER SQUARE RD
Provider Second Line Business Mailing Address:
UNIT 107
Provider Business Mailing Address City Name:
SWEDESBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08085-1863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-832-4950
Provider Business Mailing Address Fax Number:
856-832-4951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 CENTER SQUARE RD
Provider Second Line Business Practice Location Address:
UNIT 107
Provider Business Practice Location Address City Name:
SWEDESBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08085-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-832-4950
Provider Business Practice Location Address Fax Number:
856-832-4951
Provider Enumeration Date:
09/27/2005

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: 152W00000X , with the licence number:  27OA00588800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1388229 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 20-5488615 . This is a "HORIZON BLUE CROSS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K4694 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: HA1527974 . This is a "OPTICHOICE BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P27974 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3916732 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223294272 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7427497 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 20-54-88615 . This is a "CARPENTER'S WELFARE FUND" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0065307 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2804063 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7901 . This is a "EYE MED" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0000097476 . This is a "OPERATING ENGINEERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 19821 . This is a "SPECTERA AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 142-4137 . This is a "CIGNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2213488000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2213488000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2213488000 . This is a "KEYSTONE EAST MEDICAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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