Healthcare Provider Details

I. General information

NPI: 1033050919
Provider Name (Legal Business Name): NEW LEAF NP IN PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20505 MURDOCK AVE
SAINT ALBANS NY
11412-2548
US

IV. Provider business mailing address

20505 MURDOCK AVE
SAINT ALBANS NY
11412-2548
US

V. Phone/Fax

Practice location:
  • Phone: 718-930-8354
  • Fax: --
Mailing address:
  • Phone: 718-930-8354
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AUDREY FAYE BLIDGEN-TORRES
Title or Position: OWNER
Credential: PMHNP
Phone: 718-930-8354