Provider Demographics
NPI:1265652218
Name:FRISELLA-HALLER, MARGERITA M (PT)
Entity type:Individual
Prefix:MRS
First Name:MARGERITA
Middle Name:M
Last Name:FRISELLA-HALLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ATKINSON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1106
Mailing Address - Country:US
Mailing Address - Phone:516-536-5158
Mailing Address - Fax:
Practice Address - Street 1:100 NO. CENTRE AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-6301
Practice Address - Country:US
Practice Address - Phone:516-353-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ27Q41Medicare ID - Type Unspecified