Provider Demographics
NPI:1821798547
Name:HILL, JARRELL (MSED, SAS/SDA)
Entity Type:Individual
Prefix:
First Name:JARRELL
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:MSED, SAS/SDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E SOUTH ST UNIT 1041
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3577
Mailing Address - Country:US
Mailing Address - Phone:917-474-4454
Mailing Address - Fax:
Practice Address - Street 1:67 35TH ST UNIT B226
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2234
Practice Address - Country:US
Practice Address - Phone:718-522-7300
Practice Address - Fax:718-522-5280
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622123051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist