Provider Demographics
NPI:1003021718
Name:ANDERSSON, EVA (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:ANDERSSON
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 1:1010 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0130
Mailing Address - Country:US
Mailing Address - Phone:212-287-4977
Mailing Address - Fax:212-287-4936
Practice Address - Street 1:30 ROCKEFELLER PLZ
Practice Address - Street 2:ROOM 750S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10112-0002
Practice Address - Country:US
Practice Address - Phone:212-287-4977
Practice Address - Fax:212-287-4936
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191223261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health