Provider Demographics
NPI:1376840850
Name:RESTIVO, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:RESTIVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG IS CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11104-4052
Mailing Address - Country:US
Mailing Address - Phone:347-724-7265
Mailing Address - Fax:
Practice Address - Street 1:4751 40TH ST
Practice Address - Street 2:
Practice Address - City:LONG IS CITY
Practice Address - State:NY
Practice Address - Zip Code:11104-4052
Practice Address - Country:US
Practice Address - Phone:347-724-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260475207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine