Healthcare Provider Details

I. General information

NPI: 1083183271
Provider Name (Legal Business Name): TIMOTHY HALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date: 03/27/2023
Reactivation Date: 04/03/2023

III. Provider practice location address

13610 38TH AVE
FLUSHING NY
11354-4113
US

IV. Provider business mailing address

1 LAKE RD
GREAT NECK NY
11020-1609
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-5737
  • Fax:
Mailing address:
  • Phone: 917-882-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064932-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: