Provider Demographics
NPI:1942367750
Name:WAYNE, MICHAEL G (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:WAYNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:152 WOOSTER ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-5331
Mailing Address - Country:US
Mailing Address - Phone:914-345-0545
Mailing Address - Fax:212-604-3383
Practice Address - Street 1:506 6TH ST DEPT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:718-780-3288
Practice Address - Fax:718-780-3154
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY203000208600000X, 207R00000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5P5252Medicare ID - Type Unspecified
NYH05085Medicare UPIN