Healthcare Provider Details

I. General information

NPI: 1205126802
Provider Name (Legal Business Name): DAVID HASKILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MAIN ST
HACKENSACK NJ
07601-5704
US

IV. Provider business mailing address

255 MAIN ST
HACKENSACK NJ
07601-5704
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-1080
  • Fax:
Mailing address:
  • Phone: 201-342-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number25MG00103800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: