Provider Demographics
NPI:1851750665
Name:HALL, GIOVANNI
Entity Type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4111
Mailing Address - Country:US
Mailing Address - Phone:631-475-7108
Mailing Address - Fax:631-475-9601
Practice Address - Street 1:3 GROVE AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4111
Practice Address - Country:US
Practice Address - Phone:631-475-7108
Practice Address - Fax:631-475-9601
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17200000Medicaid