Provider Demographics
NPI:1790862282
Name:HYMAN, ELLIOT LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:LEWIS
Last Name:HYMAN
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 1:2818 OCEAN AVE
Mailing Address - Street 2:SUITE #8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-332-1666
Mailing Address - Fax:718-332-2666
Practice Address - Street 1:2818 OCEAN AVE
Practice Address - Street 2:SUITE #8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-332-1666
Practice Address - Fax:718-332-2666
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD112263207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00203076Medicaid
0029844OtherGHI
1000016154OtherAFFINITY
682611Medicare ID - Type Unspecified
NY00203076Medicaid