Provider Demographics
NPI:1497474043
Name:HASLAM, EGYPT
Entity Type:Individual
Prefix:
First Name:EGYPT
Middle Name:
Last Name:HASLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FAIRCHILD PL
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1002
Mailing Address - Country:US
Mailing Address - Phone:551-329-8262
Mailing Address - Fax:
Practice Address - Street 1:15 FAIRCHILD PL
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1002
Practice Address - Country:US
Practice Address - Phone:551-329-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician