Provider Demographics
NPI:1821150814
Name:HYMAN, PAUL ELLIOT (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ELLIOT
Last Name:HYMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO 931
Mailing Address - Street 2:869 BROADWAY
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3031
Mailing Address - Country:US
Mailing Address - Phone:201-823-0580
Mailing Address - Fax:201-823-3355
Practice Address - Street 1:869 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3031
Practice Address - Country:US
Practice Address - Phone:201-823-0580
Practice Address - Fax:201-823-0580
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0A003042152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ14915Medicaid