Provider Demographics
NPI:1184645459
Name:WAYE, JEROME D (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:D
Last Name:WAYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEROME
Other - Middle Name:D
Other - Last Name:WAYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL # 3000
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:212-731-5210
Practice Address - Street 1:1184 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-4299
Practice Address - Fax:212-426-5099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082589207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1184645459OtherNPI
NY131821Medicare ID - Type Unspecified