Provider Demographics
NPI:1174678825
Name:ANDRST, MILOSLAVA (MD)
Entity Type:Individual
Prefix:
First Name:MILOSLAVA
Middle Name:
Last Name:ANDRST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 MIDDLE COUNTRY RD
Mailing Address - Street 2:ELSIE OWENS NORTH BROOKHAVEN HEALTH CENTER
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-4411
Mailing Address - Country:US
Mailing Address - Phone:631-854-2301
Mailing Address - Fax:631-854-2298
Practice Address - Street 1:82 MIDDLE COUNTRY RD
Practice Address - Street 2:ELSIE OWENS NORTH BROOKHAVEN HEALTH CENTER
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4411
Practice Address - Country:US
Practice Address - Phone:631-854-2301
Practice Address - Fax:631-854-2298
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1635721Medicaid
NY08F421Medicare ID - Type Unspecified
NY1635721Medicaid