Provider Demographics
NPI:1821277567
Name:SZABO, ANDREW JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:SZABO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5856
Mailing Address - Country:US
Mailing Address - Phone:212-583-2816
Mailing Address - Fax:212-734-0382
Practice Address - Street 1:860 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5856
Practice Address - Country:US
Practice Address - Phone:212-583-2816
Practice Address - Fax:212-734-0382
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00659623Medicaid
NYB14613Medicare UPIN
NY00659623Medicaid