Provider Demographics
NPI:1518409945
Name:ANDRICKSON, EDUARDO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:ANTONIO
Last Name:ANDRICKSON
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 1:3426 103RD ST
Mailing Address - Street 2:PH
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1125
Mailing Address - Country:US
Mailing Address - Phone:917-651-6406
Mailing Address - Fax:
Practice Address - Street 1:3426 103RD ST
Practice Address - Street 2:PH
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1125
Practice Address - Country:US
Practice Address - Phone:917-651-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14-616246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant