MEDICARE: AUDREY J. WOOLRICH, MD,PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	166434	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WLW871	OTHER	NY	MEDICARE P10

General Provider Information

NPI Number	:	1215037916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDREY J. WOOLRICH, MD,PC

Provider Business Mailing Address
First Line	:	1020 PARK AVE
Second Line	:	FLOOR 1
City	:	NEW YORK
State	:	NY
Zip	:	10028-0913
Country	:	US
Telephone Number	:	212-861-7441
Fax Number	:	212-772-2877

Provider Business Practice Location Address
First Line	:	1020 PARK AVE
Second Line	:	FLOOR 1
City	:	NEW YORK
State	:	NY
Zip	:	10028-0913
Country	:	US
Telephone Number	:	212-861-7441
Fax Number	:	212-772-2877

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AUDREY JANE WOOLRICH
Credential	:	MD
Telephone Number	:	212-861-7441

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/05/2016

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