Provider Demographics
NPI:1083306765
Name:MEDICAL TELEHEATH BLUE, PLLC
Entity Type:Organization
Organization Name:MEDICAL TELEHEATH BLUE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-900-7922
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-0621
Mailing Address - Country:US
Mailing Address - Phone:516-900-7922
Mailing Address - Fax:516-268-6398
Practice Address - Street 1:4271 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5708
Practice Address - Country:US
Practice Address - Phone:516-714-3766
Practice Address - Fax:516-268-6398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty