Provider Demographics
NPI:1083810378
Name:HYZAK, SZYMON RYSZARD (MD)
Entity Type:Individual
Prefix:
First Name:SZYMON
Middle Name:RYSZARD
Last Name:HYZAK
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 1:2280 GRAND AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3164
Mailing Address - Country:US
Mailing Address - Phone:516-442-5151
Mailing Address - Fax:516-442-5152
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3164
Practice Address - Country:US
Practice Address - Phone:516-442-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2433732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry