Provider Demographics
NPI:1922467448
Name:HYSON, JOHN IV
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HYSON
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2219
Mailing Address - Country:US
Mailing Address - Phone:410-935-7955
Mailing Address - Fax:
Practice Address - Street 1:150 55TH ST
Practice Address - Street 2:NYU LUTHERAN DENTAL DEPARTMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2508
Practice Address - Country:US
Practice Address - Phone:718-630-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program