1518357375 NPI number — HALSEY FAMILY HEALTH NURSE PRACTITIONER SERVICES OF NEW YORK, PC

Table of content: (NPI 1518357375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518357375 NPI number — HALSEY FAMILY HEALTH NURSE PRACTITIONER SERVICES OF NEW YORK, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALSEY FAMILY HEALTH NURSE PRACTITIONER SERVICES OF NEW YORK, PC
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:
6
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:
1518357375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1086 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 3-5
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11221-3376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-602-2086
Provider Business Mailing Address Fax Number:
718-602-2087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13423 229TH ST
Provider Second Line Business Practice Location Address:
PVT
Provider Business Practice Location Address City Name:
LAURELTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11413-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-376-3772
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
KERAN
Authorized Official Middle Name:
SEVENISE
Authorized Official Title or Position:
DIRECTOR/PRIMARY CARE PROVIDER
Authorized Official Telephone Number:
718-602-2086

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  333879 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03815327 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com