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General NPI Number Information
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NPI Number | 1760802490
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Entity Type | Individual
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Provider Name | EDWIN DHALL
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Gender | Female
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 712 BROADWAY
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City | BRENTWOOD
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State | NY
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Zip | 11717-6922
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Country | US
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Telephone | 631-456-8854
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Fax | 631-561-4245
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Provider Business Mailing Address
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Address Line | 712 BROADWAY
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City | BRENTWOOD
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State | NY
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Zip | 11717-6922
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Country | US
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Telephone | 631-456-8854
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Fax | 631-561-4245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | C13-26498
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License Number State | NY
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