Provider Demographics
NPI:1457686651
Name:JARDIN, AUDREY (LAC)
Entity Type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:
Last Name:JARDIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 23RD ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6341
Mailing Address - Country:US
Mailing Address - Phone:917-213-7044
Mailing Address - Fax:
Practice Address - Street 1:119 W 23RD ST STE 1000
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6341
Practice Address - Country:US
Practice Address - Phone:917-213-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003756171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist