Provider Demographics
NPI:1215256425
Name:HYMAN, DEBORAH ELLYN (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELLYN
Last Name:HYMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:DEBORAY
Other - Middle Name:ELLYN
Other - Last Name:TUCACRONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:69 WEST 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-477-0430
Mailing Address - Fax:212-477-0753
Practice Address - Street 1:69 W 9TH STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-477-0430
Practice Address - Fax:212-477-0753
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043826122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice