Provider Demographics
NPI:1265902936
Name:HALBERSTAM, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HALBERSTAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 CAFFREY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4426
Mailing Address - Country:US
Mailing Address - Phone:516-272-6851
Mailing Address - Fax:
Practice Address - Street 1:1034 BROADWAY
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1228
Practice Address - Country:US
Practice Address - Phone:516-295-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist