Provider Demographics
NPI:1659114056
Name:DEKEL MEDICAL
Entity type:Organization
Organization Name:DEKEL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEVY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-586-5082
Mailing Address - Street 1:2917 MOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1614
Mailing Address - Country:US
Mailing Address - Phone:917-586-5082
Mailing Address - Fax:718-871-4474
Practice Address - Street 1:2917 MOTT AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1614
Practice Address - Country:US
Practice Address - Phone:917-586-5082
Practice Address - Fax:718-871-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center