Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA09836600 | NJ |
N | 2081P2900X | Pain Medicine | 25MA09836600 | NJ |
N | 2081P2900X | Pain Medicine | 53918 | CO |
NPI | 1336470640 |
---|---|
Provider Name | Andrew Robert Hall |
First Address | Englewood, NJ 07631-4604 |
Second Address | Englewood, NJ 07631-4604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2010 |
Last Update Date | 19/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0320820 NON-BILLING | (05) | NJ |
21530343 | (05) | CO |