Healthcare Provider Details

I. General information

NPI: 1891853248
Provider Name (Legal Business Name): HALL-DIGIOIA SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OVERLOOK RD SUITE 205
SUMMIT NJ
07901-3570
US

IV. Provider business mailing address

PO BOX 25
MADISON NJ
07940-0025
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-4500
  • Fax: 908-522-1222
Mailing address:
  • Phone: 973-616-7117
  • Fax: 973-616-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA03906200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25MA04380000
License Number StateNJ

VIII. Authorized Official

Name: STEPHEN C HALL
Title or Position: OWNER
Credential: MD
Phone: 908-522-4500