Healthcare Provider Details

I. General information

NPI: 1821396193
Provider Name (Legal Business Name): DANIEL HULL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HARRISON AVE
RIVERHEAD NY
11901-2780
US

IV. Provider business mailing address

705 BLUFFS DR N
BAITING HOLLOW NY
11933-1282
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-6748
  • Fax: 631-369-6831
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number502498-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: