Provider Demographics
NPI:1235471616
Name:PIETRIS, ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PIETRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MERRITT BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 MERRITT BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2917
Practice Address - Country:US
Practice Address - Phone:845-202-7182
Practice Address - Fax:845-202-7185
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY016817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program