Provider Demographics
NPI:1063477602
Name:HALLAK, JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:HALLAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 BROADWAY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4247
Mailing Address - Country:US
Mailing Address - Phone:516-935-0717
Mailing Address - Fax:516-935-0717
Practice Address - Street 1:183 BROADWAY
Practice Address - Street 2:SUITE 308
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4247
Practice Address - Country:US
Practice Address - Phone:516-935-0717
Practice Address - Fax:516-935-0717
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT003362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT81462Medicare UPIN
NYC27191Medicare ID - Type Unspecified