=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578536421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEIL JONATHAN HALIN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 WASHINGTON ST NEMC BOX 253
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02111-1526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-636-5947
-----------------------------------------------------
Fax | 617-636-0041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 138 ALBEMARLE RD
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02460-1135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-630-1725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | 74366
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | OS006367L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------