Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 048248 | NY |
NPI | 1366586208 |
---|---|
Provider Name | Dr. Keith Hallaian |
First Address | Smithtown, NY 11787-3520 |
Second Address | Smithtown, NY 11787-3520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02325744 | (05) | NY |