Healthcare Provider Details

I. General information

NPI: 1023803814
Provider Name (Legal Business Name): LAYNE MARTIN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 58TH ST STE 409
NEW YORK NY
10022-1163
US

IV. Provider business mailing address

57 W 75TH ST APT 1A
NEW YORK NY
10023-2007
US

V. Phone/Fax

Practice location:
  • Phone: 917-748-0816
  • Fax:
Mailing address:
  • Phone: 212-764-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LAYNE MARTIN
Title or Position: DENTIST
Credential: DDS
Phone: 917-748-0816