Healthcare Provider Details

I. General information

NPI: 1598765679
Provider Name (Legal Business Name): GARY HYMES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S MAIN ST
PLEASANTVILLE NJ
08232
US

IV. Provider business mailing address

214 S MAIN ST
PLEASANTVILLE NJ
08232
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-1515
  • Fax: 609-641-1829
Mailing address:
  • Phone: 609-641-1515
  • Fax: 609-641-1829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25M00008940
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: