Organization
EXCELSIOR INTEGRATED MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEOGRE HALL M.D. (PRESIDENT)
(718) 938-3188
Entity
Organization
Contact information
Practice address
217 GRAND ST, SUITE 401, NEW YORK, NY 10013-4396
(212) 390-1830
(212) 390-8177
Mailing address
217 GRAND ST, SUITE 401, NEW YORK, NY 10013-4396
(212) 390-1830
(212) 390-8177
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
9389049
NY
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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