1003873332 NPI number — JENNY HYPPOLITE MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003873332 NPI number — JENNY HYPPOLITE MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HYPPOLITE

Provider First Name:

JENNY

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1003873332

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/23/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 602522

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CHARLOTTE

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

28260-2522

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

252-633-1010

Provider Business Mailing Address Fax Number:

252-224-3071

Provider First Line Business Practice Location Address:

2604 DR MARTIN LUTHER KING JR BLVD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

NEW BERN

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

28562-4238

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

252-638-4023

Provider Business Practice Location Address Fax Number:

252-633-2833

Provider Enumeration Date:

04/28/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  229513 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 2009-00116 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 159911BJ . This is a "PREFERRED CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 229513-7W . This is a "WORKERS COMP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 000528062002 . This is a "HEALTH NOW BCBS #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 00026311602 . This is a "UNIVERA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 040426035712 . This is a "FIDELIS CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P00245255 . This is a "MEDICARE RAILROAD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0145199 . This is a "GHI PPO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0197357 . This is a "IHA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5910994 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 151T3 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".