Provider Demographics
NPI:1811912421
Name:HISE, CLAYTON J
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:J
Last Name:HISE
Suffix:
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 1:831 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1563
Mailing Address - Country:US
Mailing Address - Phone:845-896-8400
Mailing Address - Fax:845-896-8032
Practice Address - Street 1:831 ROUTE 52
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1563
Practice Address - Country:US
Practice Address - Phone:845-896-8400
Practice Address - Fax:845-896-8032
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0325981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50065Medicare UPIN