Provider Demographics
NPI:1104174697
Name:DR. JEROME WAYE M.D., P.C.
Entity type:Organization
Organization Name:DR. JEROME WAYE M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-439-7779
Mailing Address - Street 1:650 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6115
Mailing Address - Country:US
Mailing Address - Phone:212-439-7779
Mailing Address - Fax:212-249-5349
Practice Address - Street 1:650 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6115
Practice Address - Country:US
Practice Address - Phone:212-439-7779
Practice Address - Fax:212-249-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC05839Medicare UPIN