Provider Demographics
NPI:1407182173
Name:ANDRE, BERNADETTE (OT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:ANDRE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5425
Mailing Address - Country:US
Mailing Address - Phone:718-828-9400
Mailing Address - Fax:718-409-0816
Practice Address - Street 1:1880 WATSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5425
Practice Address - Country:US
Practice Address - Phone:718-828-9400
Practice Address - Fax:718-409-0816
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01-2041-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01-2041-1OtherOT