Healthcare Provider Details

I. General information

NPI: 1063336246
Provider Name (Legal Business Name): VINCENT BRIAN HALL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W MERRICK RD
VALLEY STREAM NY
11580-5511
US

IV. Provider business mailing address

140 W MERRICK RD
VALLEY STREAM NY
11580-5511
US

V. Phone/Fax

Practice location:
  • Phone: 516-568-4444
  • Fax: 516-708-4690
Mailing address:
  • Phone: 516-568-4444
  • Fax: 516-708-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number014847-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: