Healthcare Provider Details

I. General information

NPI: 1669417572
Provider Name (Legal Business Name): AUDREY I PREFER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E MAIN ST
MENDHAM NJ
07945-1503
US

IV. Provider business mailing address

19 E MAIN ST
MENDHAM NJ
07945-1503
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-4440
  • Fax: 973-543-3009
Mailing address:
  • Phone: 973-543-4440
  • Fax: 973-543-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA049340
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: