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General NPI Number Information
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NPI Number | 1588991616
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Entity Type | Organization
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Legal Business Name | EDWARD J HALLAL JR MD PC
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 180 E MAIN ST
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City | BAY SHORE
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State | NY
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Zip | 11706-8427
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Country | US
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Telephone | 631-665-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 180 E MAIN ST
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City | BAY SHORE
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State | NY
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Zip | 11706-8427
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Country | US
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Telephone | 631-665-0027
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD J HALLAL
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Credential | MD
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Telephone | 631-665-0027
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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 | 1705110
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License Number State | NY
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