Healthcare Provider Details

I. General information

NPI: 1063807592
Provider Name (Legal Business Name): HALLEY MARISA HINDMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD
GREENWICH CT
06830-4608
US

IV. Provider business mailing address

59 HILLCREST PARK RD
OLD GREENWICH CT
06870-1019
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3409
  • Fax:
Mailing address:
  • Phone: 203-249-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number306136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: