Robert Ira Halle, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

041683 Issued in NY

Practice address

652 Suffolk Ave
Suite #102
Brentwood, NY 11717

Phone

(631) 673-8060

Fax

(631) 273-5255

NPI assigned

Apr 11, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 29, 2015 through Dec 29, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281571200000",
    "number": "1902029366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 SUFFOLK AVE",
            "address_2": "SUITE #102",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "11717",
            "telephone_number": "631-673-8060",
            "fax_number": "631-273-5255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 SUFFOLK AVE",
            "address_2": "SUITE #102",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "11717",
            "telephone_number": "631-673-8060",
            "fax_number": "631-273-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLE",
        "first_name": "ROBERT",
        "middle_name": "IRA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2010-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "041683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA DENTAL LICENSE",
            "identifier": "38006",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josette Marie Guillaume
• Rosemond Guillaume Jr., L.P.N.
• Gary Gumbs
• Laura Hagmeyer, LMSW
• Rosemarie Hahn, RNII, NA1
• In Ho Han, M.D.
• Christine Hanley
• Harmonic Physical Therapy P.C.
• Linda J Hawkins
• Healthy Minds in Motion Psychiatric NP Services PLLC

• General Practice Dentistry in Brentwood, NY
• Providers in Brentwood, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.