MEDICARE: HALA BOKTOR I

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	207RP1001X	Pulmonary Disease Physician	341391	NY

General Provider Information

NPI Number	:	1386096378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALA BOKTOR I

Provider Business Mailing Address
First Line	:	30 BERGEN ST RM 1205
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-3000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 BERGEN ST # UHH245
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103
Country	:	US
Telephone Number	:	973-972-5672
Fax Number	:

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

Provider Enumeration Date	:	07/01/2016
Last Update Date	:	01/20/2026

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Directions to “ HALA BOKTOR I ” Practice Location

Language	Start Address	Practice Location

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