Basic Information
| Provider Information | |||||||||
| NPI: | 1316980626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAYNES | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8906 135TH ST | ||||||||
| Address2: | 7L | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182066984 | ||||||||
| FaxNumber: | 7182066786 | ||||||||
| Practice Location | |||||||||
| Address1: | 1335 LINDEN BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405100 | ||||||||
| FaxNumber: | 7182405498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | 190860 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 01789124 | 05 | NY | MEDICAID |