Provider Demographics
NPI:1124184262
Name:HALLEY, BRIAN L (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:HALLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-3304
Mailing Address - Country:US
Mailing Address - Phone:631-828-2670
Mailing Address - Fax:
Practice Address - Street 1:543 CANAL RD
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-3304
Practice Address - Country:US
Practice Address - Phone:631-828-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0222792251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP2151Medicare ID - Type UnspecifiedMEDICARE PROVIDER #