Provider Demographics
NPI:1003156027
Name:MARKEVYCH, ANDRIY (PA)
Entity Type:Individual
Prefix:
First Name:ANDRIY
Middle Name:
Last Name:MARKEVYCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 W 25TH ST APT 1213D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2235
Mailing Address - Country:US
Mailing Address - Phone:646-492-0202
Mailing Address - Fax:
Practice Address - Street 1:2926 W 25TH ST APT 1213D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2235
Practice Address - Country:US
Practice Address - Phone:646-492-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015438-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant