Basic Information
| Provider Information | |||||||||
| NPI: | 1023566528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALAKA | ||||||||
| FirstName: | IRENE | ||||||||
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| NamePrefix: | MS. | ||||||||
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| Credential: | CNIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 INVERNESS CT | ||||||||
| Address2: | |||||||||
| City: | HOLMDEL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077332505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326090258 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1086 TEANECK RD | ||||||||
| Address2: | SUITE 4A | ||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843518459 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | 3150 | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.