Provider Demographics
NPI:1861461337
Name:HINDS, AUDREY M (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:M
Last Name:HINDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AUDREY
Other - Middle Name:M
Other - Last Name:HINDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:310 CENTRAL AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2835
Mailing Address - Country:US
Mailing Address - Phone:973-678-1631
Mailing Address - Fax:973-678-6361
Practice Address - Street 1:310 CENTRAL AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2835
Practice Address - Country:US
Practice Address - Phone:973-678-1631
Practice Address - Fax:973-678-6361
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA24461207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0352101Medicaid
NJ0352101Medicaid