Provider Demographics
NPI:1497033450
Name:HALL, DARRYL H SR (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:H
Last Name:HALL
Suffix:SR
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 1:6 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1201
Mailing Address - Country:US
Mailing Address - Phone:516-766-5429
Mailing Address - Fax:516-766-5429
Practice Address - Street 1:6 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1201
Practice Address - Country:US
Practice Address - Phone:516-766-5429
Practice Address - Fax:516-766-5429
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112419207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB80240Medicare UPIN