Provider Demographics
NPI:1518357375
Name:HALSEY FAMILY HEALTH NURSE PRACTITIONER SERVICES OF NEW YORK, PC
Entity type:Organization
Organization Name:HALSEY FAMILY HEALTH NURSE PRACTITIONER SERVICES OF NEW YORK, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRIMARY CARE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERAN
Authorized Official - Middle Name:SEVENISE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:718-602-2086
Mailing Address - Street 1:1086 BROADWAY
Mailing Address - Street 2:SUITE 3-5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3376
Mailing Address - Country:US
Mailing Address - Phone:718-602-2086
Mailing Address - Fax:718-602-2087
Practice Address - Street 1:13423 229TH ST
Practice Address - Street 2:PVT
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2516
Practice Address - Country:US
Practice Address - Phone:917-376-3772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333879261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03815327Medicaid
NYG400001577Medicare UPIN