Provider Demographics
NPI:1700853892
Name:HARPER, ANDREA A (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:A
Last Name:HARPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 BROAD STREET
Mailing Address - Street 2:STE 104
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-1806
Mailing Address - Country:US
Mailing Address - Phone:973-707-7057
Mailing Address - Fax:201-998-1717
Practice Address - Street 1:39 SEELEY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1806
Practice Address - Country:US
Practice Address - Phone:201-998-1717
Practice Address - Fax:201-998-1793
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMA68103207W00000X
NYK3225207W00000X
NJMA68103207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7732007Medicaid
NJ7732007Medicaid
NJ017784Medicare ID - Type Unspecified