Provider Demographics
NPI:1427167469
Name:HAYNES, NEIL D (PA)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:D
Last Name:HAYNES
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2629
Mailing Address - Country:US
Mailing Address - Phone:607-431-5305
Mailing Address - Fax:607-431-5723
Practice Address - Street 1:739 NEW YORK HIGHWAY 28
Practice Address - Street 2:SUITE 9
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820
Practice Address - Country:US
Practice Address - Phone:607-431-5052
Practice Address - Fax:607-431-5057
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5760Medicare ID - Type Unspecified
NYR85714Medicare UPIN