1356493282 NPI number — DR. QUENTIN OLIVER HYDER MD

Table of content: DR. QUENTIN OLIVER HYDER MD (NPI 1356493282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356493282 NPI number — DR. QUENTIN OLIVER HYDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYDER
Provider First Name:
QUENTIN
Provider Middle Name:
OLIVER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1356493282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 GRAND CONCOURSE
Provider Second Line Business Mailing Address:
NARCO FREEDOM INCORPORATED
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10451-5430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-292-2240
Provider Business Mailing Address Fax Number:
718-292-3030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 E 147TH STREET
Provider Second Line Business Practice Location Address:
NEW BEGINNINGS COMMUNITY COUNSELING CENTER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-665-2456
Provider Business Practice Location Address Fax Number:
718-402-5312
Provider Enumeration Date:
01/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084A0401X , with the licence number:  0956931 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)