Provider Demographics
NPI:1689691594
Name:NICHOLAS R HALPER MD PC
Entity Type:Organization
Organization Name:NICHOLAS R HALPER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-536-2221
Mailing Address - Street 1:55 MAPLE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4267
Mailing Address - Country:US
Mailing Address - Phone:516-536-2221
Mailing Address - Fax:516-764-8747
Practice Address - Street 1:55 MAPLE AVE STE 102
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4267
Practice Address - Country:US
Practice Address - Phone:516-536-2221
Practice Address - Fax:516-764-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WKW311Medicare PIN