Provider Demographics
NPI:1932363561
Name:JOSEPH HALLAK
Entity Type:Organization
Organization Name:JOSEPH HALLAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-935-0717
Mailing Address - Street 1:183 BROADWAY STE 308
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4242
Mailing Address - Country:US
Mailing Address - Phone:516-935-0717
Mailing Address - Fax:
Practice Address - Street 1:183 BROADWAY STE 308
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4242
Practice Address - Country:US
Practice Address - Phone:516-935-0717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV3362332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00734116Medicaid
T81462Medicare UPIN
NY00734116Medicaid