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

Table of content: DR. SALLY HALIM O.D. (NPI 1063408805)

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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