Doctor Name: | SHIRLEY JOHNSON-HALL |
NPI Number: | 1265591952 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 234410 |
Business Practice Address: | 931 Hallock Avenue Port Jefferson Station, NY - 11776 |
Business Phone Number: | 6313317200 |
Business Fax Number: | 6313318636 |
Mailing Address: | 931 Hallock Avenue, PORT JEFFERSON STATION |
State: | NY |
Postal Code: | 11776 |
Phone Number: | 6313317200 |
Fax Number: | 6313318636 |
NPI Enumeration Date: | 12/08/2006 |
NPI Last Update Date: | 05/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 234410 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |