=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063425833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL FRANK HALUSKA D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 02/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4201 EDGMONT AVE
-----------------------------------------------------
City | BROOKHAVEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19015-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-874-8431
-----------------------------------------------------
Fax | 610-874-8288
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4201 EDGMONT AVE
-----------------------------------------------------
City | BROOKHAVEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19015-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-874-8431
-----------------------------------------------------
Fax | 610-874-8288
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | SC001693L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------