MEDICARE: REBECCA HALTON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	018930	NY

General Provider Information

NPI Number	:	1023358082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA HALTON PA

Provider Business Mailing Address
First Line	:	6 LARSEN AVE
Second Line	:
City	:	GLENWOOD LANDING
State	:	NY
Zip	:	11547-3012
Country	:	US
Telephone Number	:	617-699-0612
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 64TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4745
Country	:	US
Telephone Number	:	929-441-4334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	03/14/2019

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Directions to “ REBECCA HALTON PA” Practice Location

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