Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 330819 | NY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 330819 | NY |
NPI | 1053414250 |
---|---|
Provider Name | Elizabeth Geralyn Hall |
First Address | Syracuse, NY 13212 |
Second Address | Syracuse, NY 13202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 01/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02246413C | (05) | NY |
P48750 | (02) | NY |