Provider Demographics
NPI:1598723272
Name:REBARBER, ANDREI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:
Last Name:REBARBER
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 E 90TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1233
Mailing Address - Country:US
Mailing Address - Phone:212-722-7409
Mailing Address - Fax:212-722-7185
Practice Address - Street 1:190 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3106
Practice Address - Country:US
Practice Address - Phone:212-722-7409
Practice Address - Fax:212-722-7185
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06811400174400000X
NY191616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ202269647Medicaid
NJ202269647Medicaid