Provider Demographics
NPI:1538726229
Name:HALAJIAN, SAMUEL JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JOHN
Last Name:HALAJIAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4226
Mailing Address - Country:US
Mailing Address - Phone:518-886-5600
Mailing Address - Fax:
Practice Address - Street 1:24 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4226
Practice Address - Country:US
Practice Address - Phone:518-886-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024547363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical