Healthcare Provider Details

I. General information

NPI: 1740498468
Provider Name (Legal Business Name): HARVEY STA HALFOND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 HILLSIDE AVE
WILLISTON PARK NY
11596-1701
US

IV. Provider business mailing address

182 HILLSIDE AVE
WILLISTON PARK NY
11596-1701
US

V. Phone/Fax

Practice location:
  • Phone: 516-746-6251
  • Fax: 516-746-5078
Mailing address:
  • Phone: 516-746-6251
  • Fax: 516-746-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number022792
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: