MEDICARE: AUDANIS VERTUS MD

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	207R00000X	Internal Medicine Physician	198949	NY

General Provider Information

NPI Number	:	1376509737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDANIS VERTUS MD

Provider Business Mailing Address
First Line	:	931 E 105TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-2803
Country	:	US
Telephone Number	:	718-245-3309
Fax Number	:	718-245-3715

Provider Business Practice Location Address
First Line	:	309 WINTHROP ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3813
Country	:	US
Telephone Number	:	718-953-7770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	01/06/2025

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