Provider Demographics
NPI:1669579652
Name:HYDE, PHYLLIS S (MD)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:S
Last Name:HYDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4812
Mailing Address - Country:US
Mailing Address - Phone:718-855-1124
Mailing Address - Fax:718-855-1107
Practice Address - Street 1:46 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4812
Practice Address - Country:US
Practice Address - Phone:718-855-1124
Practice Address - Fax:718-855-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148894207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01039587Medicaid
NY01039587Medicaid
74D551Medicare PIN