Provider Demographics
NPI:1538275425
Name:RAY, AUDELL W (MD)
Entity type:Individual
Prefix:
First Name:AUDELL
Middle Name:W
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PONDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3809
Mailing Address - Country:US
Mailing Address - Phone:914-337-8844
Mailing Address - Fax:914-337-2270
Practice Address - Street 1:77 PONDFIELD RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708
Practice Address - Country:US
Practice Address - Phone:914-337-8844
Practice Address - Fax:914-337-2270
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125693207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00519728Medicaid
NY90124OtherUS HEALTHCARE
NYWS044OtherOXFORD
NYWS044OtherOXFORD
C08880Medicare UPIN