Provider Demographics
NPI:1720084205
Name:PAYNE, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 46TH ST RM 202
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-9287
Mailing Address - Country:US
Mailing Address - Phone:917-514-0850
Mailing Address - Fax:516-537-5371
Practice Address - Street 1:20 E 46TH ST RM 202
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9287
Practice Address - Country:US
Practice Address - Phone:917-514-0850
Practice Address - Fax:516-537-5371
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159788-6174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01063267Medicaid
NY05211SOtherGHI MEDICARE
NYN31592OtherHEALTH NET
NY05211SOtherGHI MEDICARE
NYN31592OtherHEALTH NET