Provider Demographics
NPI:1720052095
Name:KAYNE, ROBERT L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:KAYNE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22055 46TH AVE
Mailing Address - Street 2:5-V
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3601
Mailing Address - Country:US
Mailing Address - Phone:917-971-2166
Mailing Address - Fax:718-229-4030
Practice Address - Street 1:22055 46TH AVE
Practice Address - Street 2:5-V
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3601
Practice Address - Country:US
Practice Address - Phone:917-971-2166
Practice Address - Fax:718-229-4030
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010202103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02728994Medicaid
NY02728994Medicaid