=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568762433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVAN JOHN KAYE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2010
-----------------------------------------------------
Last Update Date | 10/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 MADISON AVE SUITE 1910
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-5403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-481-1326
-----------------------------------------------------
Fax | 212-504-2755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 MADISON AVE SUITE 1910
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-5403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-481-1326
-----------------------------------------------------
Fax | 212-504-2755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 33385
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------