MEDICARE: DR. HENDRIK IVO UYTTENDAELE M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	226873	NY
2	174400000X	Specialist	226873-1	NY

General Provider Information

NPI Number	:	1194781039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENDRIK IVO UYTTENDAELE M.D., PH.D.

Provider Business Mailing Address
First Line	:	969 MAIN ST STE D
Second Line	:
City	:	FISHKILL
State	:	NY
Zip	:	12524-1791
Country	:	US
Telephone Number	:	845-896-7730
Fax Number	:	845-896-7758

Provider Business Practice Location Address
First Line	:	969 MAIN ST STE D
Second Line	:
City	:	FISHKILL
State	:	NY
Zip	:	12524-1791
Country	:	US
Telephone Number	:	845-896-7730
Fax Number	:	845-896-7758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	02/13/2026

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