Provider Demographics
NPI:1114977998
Name:AU, WINNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:WINNIE
Middle Name:
Last Name:AU
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 1:630 W 168TH ST
Mailing Address - Street 2:MC28
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-1948
Mailing Address - Fax:212-305-5777
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:MC28
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-1948
Practice Address - Fax:212-305-5777
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2269232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW35021OtherMEDICARE GROUP#
NY02780138Medicaid
NY1107003OtherMEDICAID GROUP#
NY1114977998OtherPROVIDER NPI#
NY1467560854OtherMEDICARE GROUP NPI
NYW35021OtherMEDICARE GROUP#
NY1107003OtherMEDICAID GROUP#