MEDICARE: DR. SUSAN L HYMAN MD

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	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	198538	NY
2	2080P0006X	Developmental - Behavioral Pediatrics Physician	198538	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639107949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN L HYMAN MD

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE
Second Line	:	BOX 671
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-7264
Fax Number	:	585-275-3366

Provider Business Practice Location Address
First Line	:	601 ELMWOOD AVE
Second Line	:	BOX 671
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-7264
Fax Number	:	585-275-3366

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/03/2023

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