Individual
EDWIN DHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
712 BROADWAY, BRENTWOOD, NY 11717-6922
(631) 456-8854
(631) 561-4245
Mailing address
712 BROADWAY, BRENTWOOD, NY 11717-6922
(631) 456-8854
(631) 561-4245
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
C13-26498
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
352479821
HMO
NY
Enumeration date
04/21/2014
Last updated
04/21/2014
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