Provider Demographics
NPI:1609380294
Name:IYEKE, ANDREAS
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:
Last Name:IYEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 S FULTON AVE APT 8C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1434
Mailing Address - Country:US
Mailing Address - Phone:347-207-2972
Mailing Address - Fax:
Practice Address - Street 1:266 S FULTON AVE APT 8C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1434
Practice Address - Country:US
Practice Address - Phone:347-207-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY700811163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool