Provider Demographics
NPI:1609950187
Name:RAE-LAYNE, NORMA A (MD)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:A
Last Name:RAE-LAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:A
Other - Last Name:RAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:59 MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5341
Mailing Address - Country:US
Mailing Address - Phone:862-766-5363
Mailing Address - Fax:862-766-5363
Practice Address - Street 1:59 MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5341
Practice Address - Country:US
Practice Address - Phone:862-766-5363
Practice Address - Fax:862-766-5363
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD08642300OtherCDS
NJ0054003Medicaid
NJ25MA07844500OtherLICENCE
510501409OtherTAX ID
NJ0054003Medicaid
NJ088528Medicare PIN