Provider Demographics
NPI:1629317623
Name:ANDREW M G DAVY MD PC
Entity Type:Organization
Organization Name:ANDREW M G DAVY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M G
Authorized Official - Last Name:DAVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-596-2824
Mailing Address - Street 1:71 S ORANGE AVE
Mailing Address - Street 2:314
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1715
Mailing Address - Country:US
Mailing Address - Phone:718-596-2824
Mailing Address - Fax:718-596-2867
Practice Address - Street 1:14809 NORTHERN BLVD
Practice Address - Street 2:1K
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4308
Practice Address - Country:US
Practice Address - Phone:718-596-2824
Practice Address - Fax:718-596-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA207878208100000X
NY0189163208VP0014X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty