Provider Demographics
NPI:1629158944
Name:GWYNN, NAOMI HAYES (MD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:HAYES
Last Name:GWYNN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:119 W 57TH ST
Mailing Address - Street 2:SUITE 516
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2303
Mailing Address - Country:US
Mailing Address - Phone:212-582-0400
Mailing Address - Fax:212-582-0400
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 516
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-582-0400
Practice Address - Fax:212-582-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2262472084P0800X
CT0408812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY460BY1Medicare PIN