Provider Demographics
NPI:1326116575
Name:HYND, JAMIE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:WILLIAM
Last Name:HYND
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 1:921 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-393-2850
Mailing Address - Fax:315-393-3541
Practice Address - Street 1:921 STATE STREET
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-393-2850
Practice Address - Fax:315-393-3541
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228354-1204D00000X
NY228354207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02391380Medicaid
NY134225447Medicare PIN
NYH74249Medicare UPIN
NY02391380Medicaid