Provider Demographics
NPI:1134196553
Name:HALTON, PATRICIA (PA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:HALTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 RIVERDALE AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1845
Mailing Address - Country:US
Mailing Address - Phone:718-549-4267
Mailing Address - Fax:718-884-4885
Practice Address - Street 1:3765 RIVERDALE AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1845
Practice Address - Country:US
Practice Address - Phone:718-549-4267
Practice Address - Fax:718-884-4885
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010507363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMH1214117Medicare UPIN