Provider Demographics
NPI:1891149902
Name:HALBERSTAM, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HALBERSTAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YEHUDIS
Other - Middle Name:
Other - Last Name:KAHANOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5505 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2000
Mailing Address - Country:US
Mailing Address - Phone:347-893-5087
Mailing Address - Fax:
Practice Address - Street 1:1551 CARROLL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5329
Practice Address - Country:US
Practice Address - Phone:347-893-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist