Provider Demographics
NPI:1790967644
Name:HALEY PROFESSIONAL COMPANY
Entity Type:Organization
Organization Name:HALEY PROFESSIONAL COMPANY
Other - Org Name:HALEY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-281-3366
Mailing Address - Street 1:10 DUNDAFF ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1869
Mailing Address - Country:US
Mailing Address - Phone:570-281-3366
Mailing Address - Fax:570-281-3373
Practice Address - Street 1:10 DUNDAFF ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1869
Practice Address - Country:US
Practice Address - Phone:570-281-3366
Practice Address - Fax:570-281-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009640L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
002913OtherFIRST PRIORITY HEALTH
51793OtherGEISINGER
PA001703829Medicaid
G77652Medicare UPIN
002913OtherFIRST PRIORITY HEALTH