1609950187 NPI number — NORMA A RAE-LAYNE M.D.

Table of content: NORMA A RAE-LAYNE M.D. (NPI 1609950187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609950187 NPI number — NORMA A RAE-LAYNE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAE-LAYNE
Provider First Name:
NORMA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAE
Provider Other First Name:
NORMA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609950187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052-5341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
862-766-5363
Provider Business Mailing Address Fax Number:
862-766-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
59 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
WEST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07052-5341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
862-766-5363
Provider Business Practice Location Address Fax Number:
862-766-5363
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D08642300 . This is a "CDS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0054003 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25MA07844500 . This is a "LICENCE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 510501409 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".




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