Healthcare Provider Details

I. General information

NPI: 1255255352
Provider Name (Legal Business Name): PRIMARY VASCULAR CARE MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ELM ST
WEST HEMPSTEAD NY
11552-3223
US

IV. Provider business mailing address

9011 LINWOOD ST # 1029
DETROIT MI
48206-1956
US

V. Phone/Fax

Practice location:
  • Phone: 845-572-7760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIEZER HALPERT
Title or Position: OWNER
Credential:
Phone: 845-572-7760