Provider Demographics
NPI:1063614980
Name:AUSTIN, AMY F (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:F
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:72 W JIMMIE LEEDS RD
Mailing Address - Street 2:STE 1100
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9406
Mailing Address - Country:US
Mailing Address - Phone:609-677-9729
Mailing Address - Fax:
Practice Address - Street 1:44 E JIMMIE LEEDS RD
Practice Address - Street 2:STE 101
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9599
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:609-652-6512
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA088990002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0239356Medicaid
NJ215529ZDDPMedicare PIN
NJ215529AMLMedicare PIN
NJ215529ZEKDMedicare PIN