Provider Demographics
NPI:1689966343
Name:CHONG-GAYLE, AUDREY (MD)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:CHONG-GAYLE
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 1:215 ISLIP AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3028
Mailing Address - Country:US
Mailing Address - Phone:631-277-0558
Mailing Address - Fax:631-277-0978
Practice Address - Street 1:215 ISLIP AVE
Practice Address - Street 2:STE 1
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3028
Practice Address - Country:US
Practice Address - Phone:631-277-0558
Practice Address - Fax:631-277-0978
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214816208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02022351Medicaid