Healthcare Provider Details

I. General information

NPI: 1710854526
Provider Name (Legal Business Name): KEN HALL ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 TURIN RD
ROME NY
13440-1910
US

IV. Provider business mailing address

8080 TURIN RD
ROME NY
13440-1910
US

V. Phone/Fax

Practice location:
  • Phone: 315-922-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY IRIZARRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 315-525-0432