=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326116575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE WILLIAM HYND M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 06/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 921 STATE STREET
-----------------------------------------------------
City | OGDENSBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-393-2850
-----------------------------------------------------
Fax | 315-393-3541
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 921 STATE STREET
-----------------------------------------------------
City | OGDENSBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-393-2850
-----------------------------------------------------
Fax | 315-393-3541
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | 228354-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 228354
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------