Healthcare Provider Details

I. General information

NPI: 1356493282
Provider Name (Legal Business Name): QUENTIN OLIVER HYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 147TH STREET NEW BEGINNINGS COMMUNITY COUNSELING CENTER
BRONX NY
10455
US

IV. Provider business mailing address

250 GRAND CONCOURSE NARCO FREEDOM INCORPORATED
BRONX NY
10451-5430
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-2456
  • Fax: 718-402-5312
Mailing address:
  • Phone: 718-292-2240
  • Fax: 718-292-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number0956931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: