Individual
AUDREY L RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
19 BRADHURST AVE, SUITE 2450N, HAWTHORNE, NY 10532
(914) 909-4168
(914) 909-4170
Mailing address
NEW YORK MEDICAL COLLEGE, REHABILITATION MEDICINE, VALHALLA, NY 10595
(914) 909-4168
(914) 909-4170
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
097972
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
097972
LICENSE
—
Enumeration date
11/17/2005
Last updated
02/27/2008
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