Provider Demographics
NPI:1619646981
Name:ANDREU, JESSICA M
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:ANDREU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CREST RD E
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1404
Mailing Address - Country:US
Mailing Address - Phone:516-698-1103
Mailing Address - Fax:
Practice Address - Street 1:4 CREST RD E
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1404
Practice Address - Country:US
Practice Address - Phone:516-698-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist