Provider Demographics
NPI:1609417955
Name:GLEASON, HYSON RAE (MED)
Entity Type:Individual
Prefix:
First Name:HYSON
Middle Name:RAE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 DALE RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1020
Mailing Address - Country:US
Mailing Address - Phone:973-493-3191
Mailing Address - Fax:
Practice Address - Street 1:162 DALE RD
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-1020
Practice Address - Country:US
Practice Address - Phone:973-493-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty