Healthcare Provider Details

I. General information

NPI: 1720991789
Provider Name (Legal Business Name): AISHA KING-HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 HEMPSTEAD TPKE # 1066
ELMONT NY
11003-2404
US

IV. Provider business mailing address

1399 HEMPSTEAD TPKE # 1066
ELMONT NY
11003-2404
US

V. Phone/Fax

Practice location:
  • Phone: 917-470-0307
  • Fax:
Mailing address:
  • Phone: 917-470-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number636643
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: