Provider Demographics
NPI:1558342261
Name:HALPERN, AUDREY L (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:L
Last Name:HALPERN
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 1:108 W 39TH ST
Mailing Address - Street 2:SUITE 1601
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-3614
Mailing Address - Country:US
Mailing Address - Phone:646-559-4659
Mailing Address - Fax:917-633-4365
Practice Address - Street 1:108 W 39TH ST
Practice Address - Street 2:SUITE 1601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3614
Practice Address - Country:US
Practice Address - Phone:646-559-4659
Practice Address - Fax:917-633-4365
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22880612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02546596Medicaid
NY02546596Medicaid
NY488N41Medicare ID - Type Unspecified