Healthcare Provider Details

I. General information

NPI: 1851736441
Provider Name (Legal Business Name): AUDUBON PRIMARY CARE MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 AUDUBON AVE
NEW YORK NY
10033-4204
US

IV. Provider business mailing address

325 AUDUBON AVE
NEW YORK NY
10033-4245
US

V. Phone/Fax

Practice location:
  • Phone: 212-281-9472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HECTOR DARIO REYES
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 917-771-9827