Healthcare Provider Details

I. General information

NPI: 1114977998
Provider Name (Legal Business Name): WINNIE AU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST MC28
NEW YORK NY
10032-3725
US

IV. Provider business mailing address

630 W 168TH ST MC28
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-1948
  • Fax: 212-305-5777
Mailing address:
  • Phone: 212-305-1948
  • Fax: 212-305-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number226923
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierW35021
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICARE GROUP#
# 2
Identifier02780138
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
Identifier1107003
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICAID GROUP#
# 4
Identifier1114977998
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerPROVIDER NPI#
# 5
Identifier1467560854
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICARE GROUP NPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: