Provider Demographics
NPI:1922008739
Name:HALATA, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:HALATA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-7507
Mailing Address - Country:US
Mailing Address - Phone:914-367-0000
Mailing Address - Fax:914-367-0001
Practice Address - Street 1:503 GRASSLANDS RD
Practice Address - Street 2:STE 201
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1503
Practice Address - Country:US
Practice Address - Phone:914-367-0000
Practice Address - Fax:914-367-0001
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2013-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1271912080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00306607Medicaid
CT003138626Medicaid
NJ7674503Medicaid
NY343401Medicare PIN