Provider Demographics
NPI:1548238538
Name:SYMONS, ANDREW BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BRUCE
Last Name:SYMONS
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 1:77 GOODELL STREET
Mailing Address - Street 2:STE 240
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1243
Mailing Address - Country:US
Mailing Address - Phone:716-645-9694
Mailing Address - Fax:716-845-6699
Practice Address - Street 1:2465 SHERIDAN DRIVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9407
Practice Address - Country:US
Practice Address - Phone:716-835-9800
Practice Address - Fax:716-835-9888
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231206207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02670042Medicaid
NY02670042Medicaid