Healthcare Provider Details

I. General information

NPI: 1043750086
Provider Name (Legal Business Name): EMERSON HALILI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 AMSTERDAM AVE
NEW YORK NY
10025-1715
US

IV. Provider business mailing address

5123 GOLDSMITH ST APT 3
ELMHURST NY
11373-4240
US

V. Phone/Fax

Practice location:
  • Phone: 212-316-7700
  • Fax:
Mailing address:
  • Phone: 917-683-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number010329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: