Provider Demographics
NPI:1407027204
Name:PIERCE, AUDREY ANN (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANN
Last Name:PIERCE
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 1:250 MILLER PLACE
Mailing Address - Street 2:SUNRISE MEDICAL LABS.
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1826
Mailing Address - Country:US
Mailing Address - Phone:631-435-1515
Mailing Address - Fax:
Practice Address - Street 1:250 MILLER PLACE
Practice Address - Street 2:SUNRISE MEDICAL LABS.
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1826
Practice Address - Country:US
Practice Address - Phone:631-435-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257379207ZP0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program