Healthcare Provider Details

I. General information

NPI: 1932430048
Provider Name (Legal Business Name): DEVORAH HALPERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RIVER AVE
LAKEWOOD NJ
08701-4738
US

IV. Provider business mailing address

73 MONTEREY CIR
LAKEWOOD NJ
08701-3066
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-1888
  • Fax: 732-367-5910
Mailing address:
  • Phone: 718-440-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00461700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: