MEDICARE: OSNA L HALLER PHD

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	103T00000X	Psychologist	2093	NJ
2	103T00000X	Psychologist	7767	NY

General Provider Information

NPI Number	:	1467521500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSNA L HALLER PHD

Provider Business Mailing Address
First Line	:	265 CEDAR LN
Second Line	:	SUITE 2
City	:	TEANECK
State	:	NJ
Zip	:	07666-3444
Country	:	US
Telephone Number	:	201-836-7419
Fax Number	:	201-692-3658

Provider Business Practice Location Address
First Line	:	265 CEDAR LN
Second Line	:	SUITE 2
City	:	TEANECK
State	:	NJ
Zip	:	07666-3444
Country	:	US
Telephone Number	:	201-836-7419
Fax Number	:	201-692-3658

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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