Healthcare Provider Details

I. General information

NPI: 1699724823
Provider Name (Legal Business Name): JEFFREY T LAYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 04/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 OLD COUNTRY RD
PLAINVIEW NY
11803-5018
US

IV. Provider business mailing address

1181 OLD COUNTRY RD
PLAINVIEW NY
11803-5018
US

V. Phone/Fax

Practice location:
  • Phone: 516-933-6060
  • Fax: 516-933-1107
Mailing address:
  • Phone: 516-933-6060
  • Fax: 516-933-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number199206
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: