Provider Demographics
NPI:1215220983
Name:MAGNANO, ANDREW (ANDREW MAGNANO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MAGNANO
Suffix:
Gender:M
Credentials:ANDREW MAGNANO
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:MAGNANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:15 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1404
Mailing Address - Country:US
Mailing Address - Phone:631-252-2951
Mailing Address - Fax:
Practice Address - Street 1:15 4TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1404
Practice Address - Country:US
Practice Address - Phone:631-252-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637329-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse