Provider Demographics
NPI:1023045358
Name:TERENTIEV, ANDREI (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREI
Middle Name:
Last Name:TERENTIEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1016
Mailing Address - Country:US
Mailing Address - Phone:201-945-4288
Mailing Address - Fax:201-945-8690
Practice Address - Street 1:103 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1016
Practice Address - Country:US
Practice Address - Phone:201-945-4288
Practice Address - Fax:201-945-8690
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6345701Medicaid
NJ6345701Medicaid
NJTE530843Medicare ID - Type Unspecified