Provider Demographics
NPI:1104847771
Name:JOE, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:JOE
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 1:701 W 168TH ST
Mailing Address - Street 2:HHSC 1509
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2704
Mailing Address - Country:US
Mailing Address - Phone:212-305-6916
Mailing Address - Fax:212-305-6889
Practice Address - Street 1:701 W 168TH ST
Practice Address - Street 2:HHSC 1509
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2704
Practice Address - Country:US
Practice Address - Phone:212-305-6916
Practice Address - Fax:212-305-6889
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193166207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01694646Medicaid
NY17N721Medicare ID - Type Unspecified
NY01694646Medicaid