Healthcare Provider Details

I. General information

NPI: 1700991239
Provider Name (Legal Business Name): TIMOTHY S HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PARKWAY CONEY ISLAND HOSPITAL
BROOKLYN NY
11235
US

IV. Provider business mailing address

2601 OCEAN PARKWAY CONEY ISLAND HOSPITAL
BROOKLYN NY
11235
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-3445
  • Fax: 718-616-4436
Mailing address:
  • Phone: 718-616-3445
  • Fax: 718-616-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number042879
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number042879
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: