Provider Demographics
NPI:1679591358
Name:HALIASOS, HELEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:C
Last Name:HALIASOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MOUNTAINVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3444
Mailing Address - Country:US
Mailing Address - Phone:908-542-3544
Mailing Address - Fax:908-542-3216
Practice Address - Street 1:136 MOUNTAINVIEW BLVD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920
Practice Address - Country:US
Practice Address - Phone:908-542-3544
Practice Address - Fax:908-542-3216
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07862300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223824190OtherGRP TAX ID NUMBER
I44481Medicare UPIN