Basic Information
Provider Information | |||||||||
NPI: | 1881848687 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HALPERT | ||||||||
FirstName: | ELIEZER | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HALPERT | ||||||||
OtherFirstName: | ELI | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 120 HICKSVILLE RD | ||||||||
Address2: |   | ||||||||
City: | BETHPAGE | ||||||||
State: | NY | ||||||||
PostalCode: | 117143443 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5167171839 | ||||||||
FaxNumber: | 6312046446 | ||||||||
Practice Location | |||||||||
Address1: | 120 HICKSVILLE RD | ||||||||
Address2: |   | ||||||||
City: | BETHPAGE | ||||||||
State: | NY | ||||||||
PostalCode: | 117143443 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5167171839 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/06/2008 | ||||||||
LastUpdateDate: | 08/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 246391 | NY | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 246391 | NY | Y |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.