Provider Demographics
NPI:1144251612
Name:HYMAN, GEORGE FREDERIC (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:FREDERIC
Last Name:HYMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 JERICHO QUADRANGLE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2720
Mailing Address - Country:US
Mailing Address - Phone:516-693-0700
Mailing Address - Fax:516-693-0271
Practice Address - Street 1:2460 FLATBUSH AVEUE
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5000
Practice Address - Country:US
Practice Address - Phone:718-252-1200
Practice Address - Fax:718-338-6303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105162207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00183413Medicaid
NYB16551Medicare UPIN
NY00183413Medicaid
NY563632Medicare ID - Type Unspecified