Provider Demographics
NPI:1598189243
Name:HETESOVA, ANDREA (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HETESOVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6301
Mailing Address - Country:US
Mailing Address - Phone:718-683-3775
Mailing Address - Fax:718-863-0611
Practice Address - Street 1:2213 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6301
Practice Address - Country:US
Practice Address - Phone:718-683-3775
Practice Address - Fax:718-863-0611
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist