Provider Demographics
NPI:1568402386
Name:HAYWOOD, NORMAN (DO)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:HAYWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N WELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3705
Mailing Address - Country:US
Mailing Address - Phone:631-226-0011
Mailing Address - Fax:631-226-1611
Practice Address - Street 1:224 N WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-3705
Practice Address - Country:US
Practice Address - Phone:631-226-0011
Practice Address - Fax:631-226-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C1803OtherACS/HEALTHNET
NY1228381P01OtherCIGNA
NY38726OtherCONN GENERAL
NY5404162OtherAETNA
NY79920OtherVYTRA
NY01540532Medicaid
NYHIP02061OtherHIP HERITAGE
NY6100704OtherGHI
NYP391810OtherOXFORD
NY5404162OtherAETNA
NY1228381P01OtherCIGNA