=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336430131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN HYDE ALDEN JR. PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2011
-----------------------------------------------------
Last Update Date | 04/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 ROBINHOOD LN
-----------------------------------------------------
City | CAMILLUS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13031-2310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-387-5701
-----------------------------------------------------
Fax | 315-435-5540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 ROBINHOOD LN
-----------------------------------------------------
City | CAMILLUS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13031-2310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-387-5701
-----------------------------------------------------
Fax | 315-435-5540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 006400
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------