Provider Demographics
NPI:1851557375
Name:HALL, DUANE S (MEDICAL DOCTOR (MD))
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:S
Last Name:HALL
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR (MD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6 BONNIE DR
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2804
Mailing Address - Country:US
Mailing Address - Phone:516-754-8334
Mailing Address - Fax:516-640-4893
Practice Address - Street 1:555 ROCKAWAY PKWY
Practice Address - Street 2:SCHULMAN AND SCHACHNE INSTITUTE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3132
Practice Address - Country:US
Practice Address - Phone:718-240-5113
Practice Address - Fax:516-640-4893
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232754208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03078159Medicaid
NYG400001035Medicare PIN
NYA400006227Medicare PIN
NY03078159Medicaid