Provider Demographics
NPI:1477564920
Name:DALSIMER, ANDREW S (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:DALSIMER
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 1:490 WEST END AVE
Mailing Address - Street 2:1-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4329
Mailing Address - Country:US
Mailing Address - Phone:212-595-0412
Mailing Address - Fax:212-501-0439
Practice Address - Street 1:490 WEST END AVE
Practice Address - Street 2:1-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4329
Practice Address - Country:US
Practice Address - Phone:212-595-0412
Practice Address - Fax:212-501-0439
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1012952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
04A231Medicare UPIN