Basic Information
Provider Information
NPI: 1407266406
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: ANDREW
MiddleName: MARTIN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 270
Address2:  
City: MASSAPEQUA PARK
State: NY
PostalCode: 117620270
CountryCode: US
TelephoneNumber: 6312642030
FaxNumber:  
Practice Location
Address1: 4500 PARSONS BLVD
Address2: FLUSHING HOSPITAL MEDICAL CENTER
City: FLUSHING
State: NY
PostalCode: 11355
CountryCode: US
TelephoneNumber: 6312642030
FaxNumber: 6312641418
Other Information
ProviderEnumerationDate: 04/30/2014
LastUpdateDate: 07/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X296074NYY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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