Provider Demographics
NPI:1447207634
Name:HUYSMAN, JEANINE (MD)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:HUYSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2002
Mailing Address - Country:US
Mailing Address - Phone:516-938-3000
Mailing Address - Fax:516-938-3239
Practice Address - Street 1:43 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2002
Practice Address - Country:US
Practice Address - Phone:516-938-3000
Practice Address - Fax:516-938-3239
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01297323Medicaid
NY58F951Medicare ID - Type Unspecified
NY01297323Medicaid