Provider Demographics
NPI:1124379490
Name:AULT, INGRID WENDY (MS)
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:WENDY
Last Name:AULT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1319
Mailing Address - Country:US
Mailing Address - Phone:718-385-3670
Mailing Address - Fax:718-385-3670
Practice Address - Street 1:9515 AVENUE B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1319
Practice Address - Country:US
Practice Address - Phone:718-385-3670
Practice Address - Fax:718-385-3670
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist