Healthcare Provider Details

I. General information

NPI: 1902074180
Provider Name (Legal Business Name): GARY S. HYMES, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S MAIN ST
PLEASANTVILLE NJ
08232-3028
US

IV. Provider business mailing address

214 S MAIN ST
PLEASANTVILLE NJ
08232-3028
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 Number25MD00089400
License Number StateNJ

VIII. Authorized Official

Name: DR. GARY S HYMES
Title or Position: DOCTOR/OWNER
Credential: DPM
Phone: 609-641-1515