Provider Demographics
NPI:1639171143
Name:HALL, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:G
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:241 CANAL ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4118
Mailing Address - Country:US
Mailing Address - Phone:212-965-1380
Mailing Address - Fax:212-965-1682
Practice Address - Street 1:241 CANAL ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4118
Practice Address - Country:US
Practice Address - Phone:212-965-1380
Practice Address - Fax:212-965-1682
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY207289OtherSTATE LICENSE
NY01761086Medicaid
NY01761086Medicaid
NY43X141Medicare ID - Type Unspecified
NY207289OtherSTATE LICENSE