Healthcare Provider Details

I. General information

NPI: 1043756760
Provider Name (Legal Business Name): HALEY ELIZABETH CARUSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 MADISON AVE SUITE 709
NEW YORK NY
10065-8404
US

IV. Provider business mailing address

654 MADISON AVE SUITE 709
NEW YORK NY
10065-8438
US

V. Phone/Fax

Practice location:
  • Phone: 212-486-7521
  • Fax:
Mailing address:
  • Phone: 212-486-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VIII. Authorized Official

Name: MR. ETHAN RUBENSCC
Title or Position: BILLING MANAGER
Credential:
Phone: 212-486-7521