Provider Demographics
NPI:1255652699
Name:HALDY, STEPHANIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:HALDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E 4TH ST
Mailing Address - Street 2:1125
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1155
Mailing Address - Country:US
Mailing Address - Phone:610-715-9824
Mailing Address - Fax:
Practice Address - Street 1:164 MADISON AVE
Practice Address - Street 2:FLOOR 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5411
Practice Address - Country:US
Practice Address - Phone:212-685-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0381761223G0001X
NY0550971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice