Provider Demographics
NPI:1215445663
Name:HYLE, JEDEDIAH P
Entity type:Individual
Prefix:
First Name:JEDEDIAH
Middle Name:P
Last Name:HYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MERRIMAC RD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1711
Mailing Address - Country:US
Mailing Address - Phone:848-448-8763
Mailing Address - Fax:
Practice Address - Street 1:309 MERRIMAC RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1711
Practice Address - Country:US
Practice Address - Phone:848-448-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker