Provider Demographics
NPI:1659431583
Name:CAMPBELL, ANDREW (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 19W
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3224
Mailing Address - Country:US
Mailing Address - Phone:917-690-2605
Mailing Address - Fax:
Practice Address - Street 1:153 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2791
Practice Address - Country:US
Practice Address - Phone:203-426-7060
Practice Address - Fax:203-270-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004660213ES0103X
CT000934213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY97124446OtherGHI
NYDMERCOther4774560001
NY134179985OtherTAX IDENTIFICATION NUMBER
NYDMERCOther4774560002
NYPH239OtherEMPIRE BC BS
NYP04660-8OtherWORKERS' COMPENSATION
NY01276420Medicaid
NYP386760OtherOXFORD
P53961Medicare ID - Type Unspecified
NYPH239OtherEMPIRE BC BS