Provider Demographics
NPI:1861475485
Name:HALEY, ROBERT J (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:HALEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 VALLEY BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1930
Mailing Address - Country:US
Mailing Address - Phone:201-531-9400
Mailing Address - Fax:201-531-9530
Practice Address - Street 1:528 VALLEY BROOK AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1930
Practice Address - Country:US
Practice Address - Phone:201-531-9400
Practice Address - Fax:201-531-9530
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04516111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6280609Medicaid
938-734OtherPHS ID
UNITED HEALTHCAREOther1336065
P 663701OtherOXFORD ID
766362OtherAMERIHEALTH ID
6589432OtherCIGNA ID
X8B071OtherWELCHOICE ID
NJU49194Medicare UPIN
NJHA 766362Medicare ID - Type Unspecified