Provider Demographics
NPI:1487798864
Name:HALEM, HARVEY L (OD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:L
Last Name:HALEM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3902
Mailing Address - Country:US
Mailing Address - Phone:718-292-9500
Mailing Address - Fax:718-292-9538
Practice Address - Street 1:399 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3902
Practice Address - Country:US
Practice Address - Phone:718-292-9500
Practice Address - Fax:718-292-9538
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV002781-1152W00000X
NJ278400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00333606Medicaid
C26741Medicare UPIN