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General NPI Number Information
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NPI Number | 1659673176
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Entity Type | Individual
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Provider Name | MARIE ANGE AUDAIN RPA-C
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Gender | Female
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Dates
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Enumeration Date | 12/04/2010
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Last Update Date | 12/17/2022
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Provider Practice Location Address
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Address Line | 327 BEACH 19TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4423
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Country | US
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Telephone | 718-869-7000
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Fax | 718-869-8622
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Provider Business Mailing Address
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Address Line | 5645 MAIN ST
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City | FLUSHING
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State | NY
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Zip | 11355-5045
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Country | US
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Telephone | 347-454-8234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 014515
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License Number State | NY
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