Provider Demographics
NPI:1811225162
Name:PAYNE, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2756 FREDERICK DOUGLASS BLVD
Mailing Address - Street 2:#5-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3072
Mailing Address - Country:US
Mailing Address - Phone:212-281-0436
Mailing Address - Fax:
Practice Address - Street 1:2756 FREDERICK DOUGLASS BLVD
Practice Address - Street 2:#5-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3072
Practice Address - Country:US
Practice Address - Phone:212-281-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123492164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse