Provider Demographics
NPI:1033122940
Name:ANDRILLI, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:ANDRILLI
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 1:10 UNION SQUARE EAST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-844-8100
Mailing Address - Fax:
Practice Address - Street 1:222 W 14TH ST
Practice Address - Street 2:BETH ISRAEL MEDICAL GROUP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7200
Practice Address - Country:US
Practice Address - Phone:212-604-1800
Practice Address - Fax:212-604-1892
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG07940Medicare UPIN
NY63X941Medicare ID - Type Unspecified