MEDICARE: DR. MARK HYMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	042422	NY

General Provider Information

NPI Number	:	1053426270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK HYMAN DDS

Provider Business Mailing Address
First Line	:	232 HILL RD
Second Line	:
City	:	GOSHEN
State	:	NY
Zip	:	10924-5057
Country	:	US
Telephone Number	:	845-294-2840
Fax Number	:	845-294-2840

Provider Business Practice Location Address
First Line	:	4504 ROUTE 55
Second Line	:	DAYTOP VILLAGE DENTAL
City	:	SWAN LAKE
State	:	NY
Zip	:	12783
Country	:	US
Telephone Number	:	845-292-6714
Fax Number	:	845-292-6714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/14/2012

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