Provider Demographics
NPI:1114972718
Name:PRZYBYLA, ANDREW C (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:PRZYBYLA
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 1:5 CRAFTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-698-2220
Mailing Address - Fax:718-698-2220
Practice Address - Street 1:5 CRAFTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-698-2220
Practice Address - Fax:718-698-2220
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106073207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665898Medicaid
NY952361Medicare ID - Type Unspecified
B20346Medicare UPIN