Provider Demographics
NPI:1083459796
Name:HALIM, DANIELLE RAE (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RAE
Last Name:HALIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:RAE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:393 BEECROFT PL
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1227
Mailing Address - Country:US
Mailing Address - Phone:732-403-5663
Mailing Address - Fax:
Practice Address - Street 1:1803 ROUTE 35
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2974
Practice Address - Country:US
Practice Address - Phone:732-531-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1221482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant