Provider Demographics
NPI:1881338077
Name:WHITMAN, JAYNE (LAC)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WATER ST APT 301
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1965
Mailing Address - Country:US
Mailing Address - Phone:908-433-6964
Mailing Address - Fax:
Practice Address - Street 1:60 WATER ST APT 301
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1965
Practice Address - Country:US
Practice Address - Phone:908-433-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007073-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist