Provider Demographics
NPI:1588679344
Name:CODISPOTI, ANDRE J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:J
Last Name:CODISPOTI
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 1:70 GILBERT ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1538
Mailing Address - Country:US
Mailing Address - Phone:845-783-0999
Mailing Address - Fax:845-783-4133
Practice Address - Street 1:70 GILBERT ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1538
Practice Address - Country:US
Practice Address - Phone:845-783-0999
Practice Address - Fax:845-783-4133
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099921-2207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB15576Medicare UPIN
NY500392Medicare ID - Type UnspecifiedPROVIDER NUMBER