Provider Demographics
NPI:1194781039
Name:UYTTENDAELE, HENDRIK IVO (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:HENDRIK
Middle Name:IVO
Last Name:UYTTENDAELE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1789
Mailing Address - Country:US
Mailing Address - Phone:845-896-7730
Mailing Address - Fax:845-896-7758
Practice Address - Street 1:969 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-896-7730
Practice Address - Fax:845-896-7758
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226873-1174400000X
NY226873207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99770Medicare UPIN
NY2K9471/2 GRP W23631Medicare ID - Type Unspecified