MEDICARE: AUDUBON PRIMARY CARE MEDICINE PLLC

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
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851736441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDUBON PRIMARY CARE MEDICINE PLLC

Provider Business Mailing Address
First Line	:	325 AUDUBON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-4245
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 AUDUBON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-4204
Country	:	US
Telephone Number	:	212-281-9472
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. HECTOR DARIO REYES
Credential	:	MBA
Telephone Number	:	917-771-9827

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	03/23/2026

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