Provider Demographics
NPI:1326095829
Name:BEBRY, ANDREW J (RVT, RCT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:BEBRY
Suffix:
Gender:M
Credentials:RVT, RCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MONTGOMERY PL
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1404
Mailing Address - Country:US
Mailing Address - Phone:516-755-0390
Mailing Address - Fax:516-755-2297
Practice Address - Street 1:10 MONTGOMERY PL
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1404
Practice Address - Country:US
Practice Address - Phone:516-755-0390
Practice Address - Fax:516-755-2297
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0162922085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY97Z091Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYW62772Medicare UPIN