1134270788 NPI number — SALLY HALIM, LLC

Table of content: (NPI 1134270788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134270788 NPI number — SALLY HALIM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALLY HALIM, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1134270788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
802 DELSEA DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASSBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08028-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-582-5550
Provider Business Mailing Address Fax Number:
856-582-5550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 DELSEA DR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASSBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08028-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-582-5550
Provider Business Practice Location Address Fax Number:
856-582-5550
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALIM
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIC PHYSICIAN
Authorized Official Telephone Number:
856-582-5550

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: 221-348-8000 . This is a "KEYSTONE EAST MEDICAL" 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: 2804603 . This is a "UNITED HEALTH CARE" 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: 147-76-9650 . This is a "NVA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 221-348-8000 . This is a "AMERIHEALTH" 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: HA1527974 (H) . This is a "OPTICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ7901 . This is a "EYEMED" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 147-76-9650 . This is a "OPERATING ENGINEERS" 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: 0065307 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19821 . This is a "SPECTERA" 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: 221-348-8000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 53916 . This is a "DAVIS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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