Provider Demographics
NPI:1720007495
Name:ANDREWS, JANNA (MD)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:Z
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:264 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4212
Mailing Address - Country:US
Mailing Address - Phone:516-663-9774
Mailing Address - Fax:516-663-8558
Practice Address - Street 1:264 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4212
Practice Address - Country:US
Practice Address - Phone:516-663-9774
Practice Address - Fax:516-663-8558
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A832720Medicaid
CA11621658OtherCAQH ID
CA11621658OtherCAQH ID
CAWA83272Medicare PIN
CA11621658OtherCAQH ID
CABA8705177OtherDEA
CA00A832720Medicaid
CAWA83272CMedicare PIN
CAWA83272EMedicare PIN
CAWA83272AMedicare PIN