Provider Demographics
NPI:1255816005
Name:MARK HALL NURSE PRACTITIONER IN PSYCHIATRY
Entity type:Organization
Organization Name:MARK HALL NURSE PRACTITIONER IN PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-500-8627
Mailing Address - Street 1:55 W 92ND ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7628
Mailing Address - Country:US
Mailing Address - Phone:646-500-8627
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY STE 1108
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3450
Practice Address - Country:US
Practice Address - Phone:646-500-8627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty