Provider Demographics
NPI:1487767570
Name:AUDAY, JOSE HORACIO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:HORACIO
Last Name:AUDAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:333 E CITY AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1516
Mailing Address - Country:US
Mailing Address - Phone:215-546-9061
Mailing Address - Fax:610-667-4764
Practice Address - Street 1:333 E CITY AVE STE 600
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1516
Practice Address - Country:US
Practice Address - Phone:215-546-9061
Practice Address - Fax:610-667-4764
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD028407L204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD68487Medicare UPIN