Provider Demographics
NPI:1063425833
Name:HALUSKA, PAUL FRANK (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FRANK
Last Name:HALUSKA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2315
Mailing Address - Country:US
Mailing Address - Phone:610-874-8431
Mailing Address - Fax:610-874-8288
Practice Address - Street 1:4201 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2315
Practice Address - Country:US
Practice Address - Phone:610-874-8431
Practice Address - Fax:610-874-8288
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001693L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0581050001Medicare NSC
PA088440Medicare PIN