Provider Demographics
NPI:1235914698
Name:BAYNE, ZOE S
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:S
Last Name:BAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 FERDON AVE
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968-1203
Mailing Address - Country:US
Mailing Address - Phone:845-480-1517
Mailing Address - Fax:
Practice Address - Street 1:706 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2038
Practice Address - Country:US
Practice Address - Phone:845-362-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343569-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse