Provider Demographics
NPI:1447596069
Name:JEFFREY A. HALPERT DPM, LLC
Entity Type:Organization
Organization Name:JEFFREY A. HALPERT DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-884-4100
Mailing Address - Street 1:5625 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2633
Mailing Address - Country:US
Mailing Address - Phone:440-884-4100
Mailing Address - Fax:440-884-4742
Practice Address - Street 1:785 E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2530
Practice Address - Country:US
Practice Address - Phone:440-884-4100
Practice Address - Fax:440-884-4742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002495213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2118416Medicaid
OHCN6929OtherRAILROAD MEDICARE
OHCN6929OtherRAILROAD MEDICARE
OH4480210002Medicare NSC