Provider Demographics
NPI:1376500157
Name:HALSDORFER, ANDREW W (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
Last Name:HALSDORFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:325 ESSJAY RD
Practice Address - Street 2:SUITE110
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8243
Practice Address - Country:US
Practice Address - Phone:716-630-1017
Practice Address - Fax:716-632-7229
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY221778-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161000580OtherCIGNA
NY00025972801OtherUNIVERA
NY0111411OtherIHA
NY161000580OtherNORTH AMERICAN PREFERRED
NY161000580OtherEMPIRE
NY110233979OtherRR MEDICARE
NY161000580OtherAETNA
NY02238342Medicaid
NY000526768001OtherHEALTH NOW
NY000526768001OtherHEALTH NOW
NY02238342Medicaid