Healthcare Provider Details

I. General information

NPI: 1033447115
Provider Name (Legal Business Name): HYLAN MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 FLATBUSH AVE
BROOKLYN NY
11226
US

IV. Provider business mailing address

775 FLATBUSH AVE
BROOKLYN NY
11226-1901
US

V. Phone/Fax

Practice location:
  • Phone: 718-484-9101
  • Fax: 347-627-4437
Mailing address:
  • Phone: 718-484-9101
  • Fax: 347-627-4437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA A ROSS
Title or Position: MANAGER
Credential:
Phone: 718-484-9101