Provider Demographics
NPI:1134397540
Name:LAYMAN-GOLDSTEIN, MARY LOUISE (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:LAYMAN-GOLDSTEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:LAYMAN GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:MSKCC BOX 52
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:646-888-2724
Mailing Address - Fax:646-888-2735
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:MSKCC BOX 52
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:646-888-2724
Practice Address - Fax:646-888-2735
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303452363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health