Provider Demographics
NPI:1417593336
Name:WARD, ANDREW STEPHEN
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEPHEN
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 MADISON AVE RM 1026
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-7725
Mailing Address - Country:US
Mailing Address - Phone:212-682-7860
Mailing Address - Fax:
Practice Address - Street 1:295 MADISON AVE RM 1026
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-7725
Practice Address - Country:US
Practice Address - Phone:612-682-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045222-012081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045222-01OtherPHYSICAL THERAPY LICENSE