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General NPI Number Information
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NPI Number | 1225452469
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Entity Type | Organization
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Legal Business Name | THEODORE HANLEY MD PLLC
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 73 JEREMY CT
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City | MONROE
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State | NJ
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Zip | 08831-8587
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Country | US
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Telephone | 347-461-2940
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 MADISON AVE OFC 1
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City | NEW YORK
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State | NY
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Zip | 10035-2745
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Country | US
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Telephone | 212-987-1777
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | THEODORE E HANLEY
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Credential | MD
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Telephone | 347-461-2940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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