Provider Demographics
NPI:1881673143
Name:HALPERN, JERRY L (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:HALPERN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 57TH ST
Mailing Address - Street 2:SUITE 914
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2303
Mailing Address - Country:US
Mailing Address - Phone:212-246-4593
Mailing Address - Fax:212-247-8701
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 914
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-246-4593
Practice Address - Fax:212-247-8701
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0310581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T49826Medicare UPIN
D5C362Medicare ID - Type Unspecified