Provider Demographics
NPI:1699004861
Name:KAYE, JEROME CHARLES (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:CHARLES
Last Name:KAYE
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4530
Mailing Address - Country:US
Mailing Address - Phone:717-394-7218
Mailing Address - Fax:717-394-7780
Practice Address - Street 1:1763 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4530
Practice Address - Country:US
Practice Address - Phone:717-394-7218
Practice Address - Fax:717-394-7780
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF02564174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist