Provider Demographics
NPI:1548375785
Name:KANE, JAMIE A (MD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:A
Last Name:KANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:865 NORTHERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5335
Mailing Address - Country:US
Mailing Address - Phone:516-622-5000
Mailing Address - Fax:516-622-5005
Practice Address - Street 1:865 NORTHERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5335
Practice Address - Country:US
Practice Address - Phone:516-622-5000
Practice Address - Fax:516-622-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2016-02-25
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Provider Licenses
StateLicense IDTaxonomies
CT044608207R00000X
NY240970207R00000X, 2083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine