Provider Demographics
NPI:1235683996
Name:ATTIA, ANDREW NADER (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:NADER
Last Name:ATTIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PARK ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1813
Mailing Address - Country:US
Mailing Address - Phone:718-619-7687
Mailing Address - Fax:
Practice Address - Street 1:1140 BAY ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4910
Practice Address - Country:US
Practice Address - Phone:718-447-7483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist