Provider Demographics
NPI:1841277803
Name:HALIBEY, BOHDAN EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:BOHDAN
Middle Name:EUGENE
Last Name:HALIBEY
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 1:100 1ST ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2153
Mailing Address - Country:US
Mailing Address - Phone:973-726-0005
Mailing Address - Fax:973-726-4668
Practice Address - Street 1:89 SPARTA AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1777
Practice Address - Country:US
Practice Address - Phone:973-726-0005
Practice Address - Fax:973-726-4668
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03718200207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1386701Medicaid
NJ510316Medicare ID - Type Unspecified
NJ1386701Medicaid