=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407377526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC MICHAEL HALEJIAN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2017
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 SPRING VALLEY MARKET PL
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10977-5210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-308-8181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 412 GLENDALE RD
-----------------------------------------------------
City | WYCKOFF
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07481-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-206-6951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 22DI02703200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 059936
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------