Healthcare Provider Details

I. General information

NPI: 1609080027
Provider Name (Legal Business Name): EARLE W HAYES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST AVE 16TH STREET 12 BAIRD HALL
NY NY
10003-3354
US

IV. Provider business mailing address

P.O BOX 95000-2433
PA PA
19195-3354
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2377
  • Fax:
Mailing address:
  • Phone: 212-420-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number230591
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS9590
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number230591
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: