Healthcare Provider Details

I. General information

NPI: 1982979563
Provider Name (Legal Business Name): MARTHA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOMERSET ST APT 229
HARRISON NJ
07029-2340
US

IV. Provider business mailing address

300 SOMERSET ST APT 229
HARRISON NJ
07029-2340
US

V. Phone/Fax

Practice location:
  • Phone: 845-520-0073
  • Fax:
Mailing address:
  • Phone: 845-520-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: