Provider Demographics
NPI:1548443401
Name:AUTRY, APRIL N (PA)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:N
Last Name:AUTRY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:129 W 29TH ST # W
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5105
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:30 BROAD ST
Practice Address - Street 2:45TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2304
Practice Address - Country:US
Practice Address - Phone:212-530-2288
Practice Address - Fax:212-867-4353
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2014-11-21
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Provider Licenses
StateLicense IDTaxonomies
NY012232363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331946Medicare Oscar/Certification