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General NPI Number Information
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NPI Number | 1255816005
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Entity Type | Organization
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Legal Business Name | MARK HALL NURSE PRACTITIONER IN PSYCHIATRY
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/23/2023
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Provider Practice Location Address
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Address Line | 1115 BROADWAY STE 1108
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City | NEW YORK
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State | NY
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Zip | 10010-3450
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Country | US
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Telephone | 646-500-8627
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Fax |
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Provider Business Mailing Address
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Address Line | 55 W 92ND ST APT 2B
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City | NEW YORK
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State | NY
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Zip | 10025-7628
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Country | US
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Telephone | 646-500-8627
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MARK HALL
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Credential | NP
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Telephone | 646-500-8627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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