Provider Demographics
NPI:1619962792
Name:HILL, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HILL
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 1:10 MEDICAL PLZ
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2193
Mailing Address - Country:US
Mailing Address - Phone:516-759-0515
Mailing Address - Fax:516-759-7183
Practice Address - Street 1:10 MEDICAL PLZ
Practice Address - Street 2:SUITE 208
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2193
Practice Address - Country:US
Practice Address - Phone:516-759-0515
Practice Address - Fax:516-759-7183
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2010-11-10
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NY148240207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01692039Medicaid
NY01692039Medicaid
00E792Medicare ID - Type Unspecified