Healthcare Provider Details

I. General information

NPI: 1063408805
Provider Name (Legal Business Name): SALLY HALIM O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CENTER SQUARE RD UNIT 107
SWEDESBORO NJ
08085-1863
US

IV. Provider business mailing address

120 CENTER SQUARE RD UNIT 107
SWEDESBORO NJ
08085-1863
US

V. Phone/Fax

Practice location:
  • Phone: 856-832-4950
  • Fax: 856-832-4951
Mailing address:
  • Phone: 856-832-4950
  • Fax: 856-832-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00588800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: