Provider Demographics
NPI:1982672978
Name:HALICZER, ABE (MD)
Entity Type:Individual
Prefix:DR
First Name:ABE
Middle Name:
Last Name:HALICZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ORIENT WAY
Mailing Address - Street 2:SUITE LL-C
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2082
Mailing Address - Country:US
Mailing Address - Phone:201-372-0401
Mailing Address - Fax:201-372-0402
Practice Address - Street 1:47 ORIENT WAY
Practice Address - Street 2:SUITE LL-C
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2082
Practice Address - Country:US
Practice Address - Phone:201-372-0401
Practice Address - Fax:201-372-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04495000207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
016400TY8OtherRENDERING INDIVIDUAL ID #
0088817OtherLEGACY #
016400TY8OtherRENDERING INDIVIDUAL ID #