Provider Demographics
NPI:1124717004
Name:HALL, PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SWAN PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1335
Mailing Address - Country:US
Mailing Address - Phone:631-901-8693
Mailing Address - Fax:
Practice Address - Street 1:29TH STREET AT AVENUE E
Practice Address - Street 2:GME-5A
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-858-6594
Practice Address - Fax:201-716-3951
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program