Provider Demographics
NPI:1609044544
Name:LLEWELLYN HYACINTHE MD PC
Entity Type:Organization
Organization Name:LLEWELLYN HYACINTHE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LLEWELLYN
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:HYACINTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-638-9222
Mailing Address - Street 1:60 PLAZA ST E
Mailing Address - Street 2:ST 1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5040
Mailing Address - Country:US
Mailing Address - Phone:718-638-9222
Mailing Address - Fax:718-857-1714
Practice Address - Street 1:60 PLAZA ST E
Practice Address - Street 2:ST 1L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5040
Practice Address - Country:US
Practice Address - Phone:718-638-9222
Practice Address - Fax:718-857-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180086208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01424322Medicaid
NY4S2611OtherEMPIRE BLUE CROSS
NY4S2611OtherEMPIRE BLUE CROSS