Provider Demographics
NPI:1003186651
Name:CHARLES L. G. HALASZ, MD
Entity Type:Organization
Organization Name:CHARLES L. G. HALASZ, MD
Other - Org Name:DERMATOLOGY FOR THE FAMILY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LUDVIG
Authorized Official - Last Name:HALASZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-853-1874
Mailing Address - Street 1:149 EAST AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5711
Mailing Address - Country:US
Mailing Address - Phone:203-853-1874
Mailing Address - Fax:203-831-0007
Practice Address - Street 1:149 EAST AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5711
Practice Address - Country:US
Practice Address - Phone:203-853-1874
Practice Address - Fax:203-831-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001214311Medicaid