Provider Demographics
NPI:1740393024
Name:HALL, EDWARD GEORGE (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GEORGE
Last Name:HALL
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
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Mailing Address - Street 1:29 RAVENNA DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3607
Mailing Address - Country:US
Mailing Address - Phone:845-362-9176
Mailing Address - Fax:845-362-9176
Practice Address - Street 1:29 RAVENNA DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3607
Practice Address - Country:US
Practice Address - Phone:845-362-9176
Practice Address - Fax:845-362-9176
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2013-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1776062084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1740393024OtherNPI