Provider Demographics
NPI:1912981317
Name:HALPER, NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:HALPER
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 1:55 MAPLE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4267
Mailing Address - Country:US
Mailing Address - Phone:516-536-2221
Mailing Address - Fax:516-764-8747
Practice Address - Street 1:55 MAPLE AVE STE 102
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4267
Practice Address - Country:US
Practice Address - Phone:516-536-2221
Practice Address - Fax:516-764-8747
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08923Medicare UPIN
345861Medicare PIN