Provider Demographics
NPI:1932588050
Name:JAMES J. HYNICK, D.O., P.A.
Entity Type:Organization
Organization Name:JAMES J. HYNICK, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:HYNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-339-3524
Mailing Address - Street 1:301 E STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5217
Mailing Address - Country:US
Mailing Address - Phone:407-339-3524
Mailing Address - Fax:407-339-3832
Practice Address - Street 1:301 E STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5217
Practice Address - Country:US
Practice Address - Phone:407-339-3524
Practice Address - Fax:407-339-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82108Medicare PIN