Provider Demographics
NPI:1841445772
Name:HALTHORE, SUSHMA (DMD)
Entity type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:HALTHORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SUSHMA
Other - Middle Name:
Other - Last Name:HOSKOTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:175 NEWARK AVE
Mailing Address - Street 2:#2B
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:917-703-0934
Mailing Address - Fax:
Practice Address - Street 1:175 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2859
Practice Address - Country:US
Practice Address - Phone:917-703-0934
Practice Address - Fax:201-435-7678
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
NJ22DI023662001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment