Provider Demographics
NPI:1770670598
Name:HALL, DAVID G (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:76 WEST JIMMIE LEEDS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9417
Mailing Address - Country:US
Mailing Address - Phone:609-404-1300
Mailing Address - Fax:609-404-1929
Practice Address - Street 1:76 WEST JIMMIE LEEDS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9417
Practice Address - Country:US
Practice Address - Phone:609-404-1300
Practice Address - Fax:609-404-1929
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00197300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4895606Medicaid
NJ617306DB8Medicare ID - Type Unspecified
NJ4895606Medicaid