Provider Demographics
NPI:1215016159
Name:ANDUJAR, MIGUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:ANDUJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:386 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6828
Mailing Address - Country:US
Mailing Address - Phone:212-923-6100
Mailing Address - Fax:212-795-0560
Practice Address - Street 1:336 FORT WASHINGTON AVENUE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033
Practice Address - Country:US
Practice Address - Phone:212-923-6100
Practice Address - Fax:212-795-0560
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140733207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12303Medicare UPIN
NY298A311Medicare ID - Type Unspecified
NYB12303Medicare UPIN
29A311Medicare PIN