Provider Demographics
NPI:1225016892
Name:LAY, VIRGINIA IRENE (MD)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:IRENE
Last Name:LAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:973-751-5454
Mailing Address - Fax:973-751-1717
Practice Address - Street 1:36 NEWARK AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109
Practice Address - Country:US
Practice Address - Phone:973-751-5454
Practice Address - Fax:973-751-1717
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50650207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E55089Medicare UPIN
NJE55089Medicare UPIN
LA610455Medicare ID - Type Unspecified