Healthcare Provider Details

I. General information

NPI: 1952936619
Provider Name (Legal Business Name): JEROME D HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WASHINGTON AVENUE EXT
ALBANY NY
12203-5304
US

IV. Provider business mailing address

375A HACKETT BLVD
ALBANY NY
12208-5106
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-7831
  • Fax: 518-456-1563
Mailing address:
  • Phone: 518-505-7583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number00-6465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: