Provider Demographics
NPI:1215037916
Name:AUDREY J. WOOLRICH, MD,PC
Entity Type:Organization
Organization Name:AUDREY J. WOOLRICH, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WOOLRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-861-7441
Mailing Address - Street 1:1020 PARK AVE
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0913
Mailing Address - Country:US
Mailing Address - Phone:212-861-7441
Mailing Address - Fax:212-772-2877
Practice Address - Street 1:1020 PARK AVE
Practice Address - Street 2:FLOOR 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0913
Practice Address - Country:US
Practice Address - Phone:212-861-7441
Practice Address - Fax:212-772-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166434207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWLW871OtherMEDICARE P10
NYD92005Medicare UPIN