Provider Demographics
NPI:1073684031
Name:HENRY, AUDREY WHILMA (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:WHILMA
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CAPITAL WAY
Mailing Address - Street 2:PSYCHIATRY DEPARTMENT
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638
Mailing Address - Country:US
Mailing Address - Phone:609-394-6085
Mailing Address - Fax:609-394-6250
Practice Address - Street 1:1 CAPITAL WAY
Practice Address - Street 2:PSYCHIATRY DEPT
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638
Practice Address - Country:US
Practice Address - Phone:609-394-6085
Practice Address - Fax:609-394-6250
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA086083002084P0800X
CAG602302084P0800X
PAMD4353122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G602300Medicaid
NJ0211362Medicaid
NJ0211362Medicaid
CA00G602300Medicaid