Provider Demographics
NPI:1104644061
Name:HALJEAN, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HALJEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BOYD ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-2004
Mailing Address - Country:US
Mailing Address - Phone:973-723-7813
Mailing Address - Fax:
Practice Address - Street 1:505 BOYD ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-2004
Practice Address - Country:US
Practice Address - Phone:973-723-7813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies