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NPI Code Detail

MEDICARE: MR. JOHN FRANCIS HALLOWELL PA-C, MBA

MEDICARE: MR. JOHN FRANCIS HALLOWELL PA-C, MBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant002768NY

General Provider Information

NPI Number : 1629066303
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN FRANCIS HALLOWELL PA-C, MBA
Provider Business Mailing Address
First Line : PO BOX 733
Second Line :
City : GREAT RIVER
State : NY
Zip : 11739-0733
Country : US
Telephone Number : 631-859-8872
Fax Number :
Provider Business Practice Location Address
First Line : 301 E MAIN ST
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8408
Country : US
Telephone Number : 631-675-4013
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2005
Last Update Date : 02/23/2016

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