Healthcare Provider Details

I. General information

NPI: 1942703988
Provider Name (Legal Business Name): SALLY HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 5TH AVE STE 3A
NEW YORK NY
10011-8855
US

IV. Provider business mailing address

2 5TH AVE STE 3A
NEW YORK NY
10011-8855
US

V. Phone/Fax

Practice location:
  • Phone: 212-598-4433
  • Fax:
Mailing address:
  • Phone: 212-598-4433
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number060397
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: