Provider Demographics
NPI:1205414331
Name:HALON, DEVORAH (LMT)
Entity Type:Individual
Prefix:MS
First Name:DEVORAH
Middle Name:
Last Name:HALON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1344
Mailing Address - Country:US
Mailing Address - Phone:917-903-4953
Mailing Address - Fax:
Practice Address - Street 1:516 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1344
Practice Address - Country:US
Practice Address - Phone:917-903-4953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029248-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist