Provider Demographics
NPI:1225029572
Name:THALL, ERIC HYIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:HYIAM
Last Name:THALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N VILLAGE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2341
Mailing Address - Country:US
Mailing Address - Phone:516-766-2929
Mailing Address - Fax:516-766-7728
Practice Address - Street 1:200 N VILLAGE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2341
Practice Address - Country:US
Practice Address - Phone:516-766-2929
Practice Address - Fax:516-766-7728
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191069208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2214116OtherAETNA
NY340017949OtherRAILROAD MEDICARE
1099460OtherGHI
136196-A32OtherHEALTH FIRST
200649OtherUNIFORMED SERVICES
2C7429OtherCARE CORE
74266OtherVYTRA
NYET055T9710OtherBLUE CROSS BLUE SHIELD
P589155OtherOXFORD
191069OtherHIP
2C7429OtherHEALTH NET
000000068631OtherGHI HMO
NY01836933Medicaid
NYG47381Medicare UPIN
NY55T9717981Medicare PIN