Healthcare Provider Details

I. General information

NPI: 1245559277
Provider Name (Legal Business Name): DEVIN JOHN HULL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 MAPLE ST SUITE #2
BIG FLATS NY
14814-9701
US

IV. Provider business mailing address

455 MAPLE ST SUITE #2
BIG FLATS NY
14814-9701
US

V. Phone/Fax

Practice location:
  • Phone: 607-562-7300
  • Fax: 607-562-7575
Mailing address:
  • Phone: 607-562-7300
  • Fax: 607-562-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0116022359
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006437
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006547-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: