Provider Demographics
NPI:1689968125
Name:HALSEY, JUNE CHANYASULKIT (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:CHANYASULKIT
Last Name:HALSEY
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 1:635 BELLE TERRE RD
Mailing Address - Street 2:STE 204
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1977
Mailing Address - Country:US
Mailing Address - Phone:631-474-0008
Mailing Address - Fax:631-474-0224
Practice Address - Street 1:686 COUNTY ROAD 39A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5703
Practice Address - Country:US
Practice Address - Phone:631-283-0355
Practice Address - Fax:631-283-2084
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2874631207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program