Provider Demographics
NPI:1669470829
Name:BAINNSON, ANDREW N (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:N
Last Name:BAINNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:260 E MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2982
Mailing Address - Country:US
Mailing Address - Phone:631-265-8780
Mailing Address - Fax:631-265-8521
Practice Address - Street 1:260 E MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2982
Practice Address - Country:US
Practice Address - Phone:631-265-8780
Practice Address - Fax:631-265-8521
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187993207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY187993Medicaid
F80253Medicare UPIN
NY187993Medicaid