Provider Demographics
NPI:1417358789
Name:RUE, ANDREA L (MED)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:RUE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 ELTON ST
Mailing Address - Street 2:APT. 5E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239
Mailing Address - Country:US
Mailing Address - Phone:347-388-1839
Mailing Address - Fax:
Practice Address - Street 1:1166 ELTON ST
Practice Address - Street 2:APT. 5E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-5805
Practice Address - Country:US
Practice Address - Phone:347-388-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY858128252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency