Healthcare Provider Details

I. General information

NPI: 1497173991
Provider Name (Legal Business Name): ASHLEY VICTORIA AUSTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 71ST ST
NEW YORK NY
10021-4828
US

IV. Provider business mailing address

535 E 70TH ST
NEW YORK NY
10021-4898
US

V. Phone/Fax

Practice location:
  • Phone: 212-774-7880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD60858540
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number318684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: