Provider Demographics
NPI:1740859016
Name:DONG, AUDREY (DO)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:DONG
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 MARLTON PIKE EAST
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:800-789-7366
Mailing Address - Fax:
Practice Address - Street 1:1865 ROUTE 70 EAST
Practice Address - Street 2:STE 210
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2013
Practice Address - Country:US
Practice Address - Phone:732-666-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS023958207Q00000X
NJ25MB12380700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine