Active NPI
Timothy Hall, DO
- Pharmacist
- Flushing, NY
National Provider Identifier
1083183271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 064932-1
- Practice address
- 13610 38TH Ave
Flushing, NY 11354-4113 - Phone
- (718) 353-5737
- NPI assigned
- Nov 16, 2018
- Reactivated
- Apr 3, 2023
- Last updated
- Apr 9, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NY | ||
| Pharmacist | 183500000X | 064932-1 | NY | Primary |
Addresses
Primary practice location
13610 38TH Ave
Flushing, NY 11354-4113
Mailing address
1 Lake Rd
Great Neck, NY 11020-1609
Phone (917) 882-0916
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 064932-1 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MMM Health Corp | Past | Accepting new patients | |
| CMD Enterprises LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775692800000",
"number": "1083183271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 LAKE RD",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110201609",
"telephone_number": "917-882-0916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13610 38TH AVE",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113544113",
"telephone_number": "718-353-5737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "TIMOTHY",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-16",
"last_updated": "2026-04-09",
"certification_date": "2026-04-09",
"deactivation_date": "2023-03-27",
"reactivation_date": "2023-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NY",
"license": null,
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "064932-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.