Basic Information
| Provider Information | |||||||||
| NPI: | 1003873332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HYPPOLITE | ||||||||
| FirstName: | JENNY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602522 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526331010 | ||||||||
| FaxNumber: | 2522243071 | ||||||||
| Practice Location | |||||||||
| Address1: | 2604 DR MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285624238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526384023 | ||||||||
| FaxNumber: | 2526332833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 03/23/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 229513 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2009-00116 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 159911BJ | 01 | NY | PREFERRED CARE # | OTHER | 229513-7W | 01 | NY | WORKERS COMP # | OTHER | 000528062002 | 01 | NY | HEALTH NOW BCBS # | OTHER | 00026311602 | 01 | NY | UNIVERA # | OTHER | 040426035712 | 01 | NY | FIDELIS CARE # | OTHER | P00245255 | 01 | NY | MEDICARE RAILROAD # | OTHER | 0145199 | 01 | NY | GHI PPO # | OTHER | 0197357 | 01 | NY | IHA # | OTHER | 5910994 | 05 | NC | MEDICAID | 151T3 | 01 | NC | BCBSNC | OTHER |