Individual
JACK DANIEL HALLIGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4321
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4321
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MT220997
PA
390200000X
Student in an Organized Health Care Education/Training Program
325482
NY
Other
Enumeration date
04/28/2020
Last updated
04/08/2025
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