Healthcare Provider Details

I. General information

NPI: 1467446112
Provider Name (Legal Business Name): MARTIN HYZINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 JEFFERSON AVE STE 205
SCRANTON PA
18510
US

IV. Provider business mailing address

743 JEFFERSON AVE STE 205
SCRANTON PA
18510
US

V. Phone/Fax

Practice location:
  • Phone: 570-558-3020
  • Fax: 570-558-3385
Mailing address:
  • Phone: 570-558-3020
  • Fax: 570-558-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM8024781E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD024781E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10409
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER
# 2
Identifier019455160001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: