MEDICARE: JOHN PAYNE

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	164W00000X	Licensed Practical Nurse	123492	NY

General Provider Information

NPI Number	:	1811225162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PAYNE

Provider Business Mailing Address
First Line	:	2756 FREDERICK DOUGLASS BLVD
Second Line	:	#5-B
City	:	NEW YORK
State	:	NY
Zip	:	10039-3072
Country	:	US
Telephone Number	:	212-281-0436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2756 FREDERICK DOUGLASS BLVD
Second Line	:	#5-B
City	:	NEW YORK
State	:	NY
Zip	:	10039-3072
Country	:	US
Telephone Number	:	212-281-0436
Fax Number	:

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

Provider Enumeration Date	:	11/25/2009
Last Update Date	:	11/25/2009

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Directions to “ JOHN PAYNE ” Practice Location

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