Provider Demographics
NPI:1912398447
Name:SUSHA C HALBERSTAM
Entity Type:Organization
Organization Name:SUSHA C HALBERSTAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAFARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-486-7710
Mailing Address - Street 1:11015 71ST RD STE P1
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4976
Mailing Address - Country:US
Mailing Address - Phone:718-793-4955
Mailing Address - Fax:
Practice Address - Street 1:11015 71ST RD STE P1
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4976
Practice Address - Country:US
Practice Address - Phone:718-793-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044412-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty