Provider Demographics
NPI:1144425448
Name:HALAC, ELIAS ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:ROBERT
Last Name:HALAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 34TH ST APT S14C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4961
Mailing Address - Country:US
Mailing Address - Phone:212-319-0763
Mailing Address - Fax:212-319-0763
Practice Address - Street 1:155 E 38TH STREEET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-490-2446
Practice Address - Fax:212-490-2446
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097502174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78193Medicare UPIN