1750571162 NPI number — SAMUEL RYAN HALPERN O. D.

Table of content: SAMUEL RYAN HALPERN O. D. (NPI 1750571162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750571162 NPI number — SAMUEL RYAN HALPERN O. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALPERN
Provider First Name:
SAMUEL
Provider Middle Name:
RYAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750571162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 BANNING ST
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19904-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-450-3025
Provider Business Mailing Address Fax Number:
302-990-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 BANNING ST STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904-3486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-678-1700
Provider Business Practice Location Address Fax Number:
302-678-2330
Provider Enumeration Date:
08/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  I30001321 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G01047 . This is a "MEDICARE GROUP PTAN - EYE SPECIALISTS OF DELAWARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 022756H16 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: ID2289 . This is a "GROUP MEDICARE PTAN - HALPERN MEDICAL SERVICES. LLC" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1245251313 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: G00016 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1346430360 . This is a "GROUP NPI - EYE SPECIALISTS OF DELAWARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: I3-0001321 . This is a "STATE LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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