Provider Demographics
NPI:1407954985
Name:WAYNE, ALYSE R (PA)
Entity Type:Individual
Prefix:MRS
First Name:ALYSE
Middle Name:R
Last Name:WAYNE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19 BEEKMAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1522
Mailing Address - Country:US
Mailing Address - Phone:212-513-7711
Mailing Address - Fax:212-513-7723
Practice Address - Street 1:19 BEEKMAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1522
Practice Address - Country:US
Practice Address - Phone:212-513-7711
Practice Address - Fax:212-513-7723
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007301-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP83281Medicare UPIN
NY5F6681Medicare PIN