Provider Demographics
NPI:1558321968
Name:CULLIFORD, ANDREA N (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:N
Last Name:CULLIFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 72ND ST
Mailing Address - Street 2:APT.8F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4553
Mailing Address - Country:US
Mailing Address - Phone:212-988-8728
Mailing Address - Fax:212-452-1099
Practice Address - Street 1:183RD STREET & THIRD AVENUE
Practice Address - Street 2:7TH FLOOR, DEPT. OF MEDICINE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-6205
Practice Address - Fax:718-960-3218
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211551207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02079427Medicaid
NY61C241Medicare ID - Type Unspecified
NY02079427Medicaid