Basic Information
| Provider Information | |||||||||
| NPI: | 1750879128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALEY | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 MATTHEWS ST | ||||||||
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| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109241962 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 17 SUSSEX ST # 19 | ||||||||
| Address2: | |||||||||
| City: | PORT JERVIS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127712430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458566344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2018 | ||||||||
| LastUpdateDate: | 05/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 633364 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.