Individual
MRS. TRACY LYNN JAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1729 BURRSTONE RD, NEW HARTFORD, NY 13413-1001
(318) 798-1514
(315) 624-1957
Mailing address
2 ELLINWOOD DR, NEW HARTFORD, NY 13413-1102
(315) 507-5081
(315) 738-1663
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
012833
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03162567
—
NY
Enumeration date
11/20/2008
Last updated
11/12/2019
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