Provider Demographics
NPI:1881848422
Name:ANDRADE, JOSEPH R (M,D)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E HARTSDALE AVE APT 3PE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3292
Mailing Address - Country:US
Mailing Address - Phone:718-808-2825
Mailing Address - Fax:
Practice Address - Street 1:4446 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2939
Practice Address - Country:US
Practice Address - Phone:646-684-3040
Practice Address - Fax:929-299-1760
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166744208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009180OtherGHI
NY1C3448OtherHEALTH NET
NY00966798Medicaid
NY0376636OtherCIGNA
NY166744OtherHIP
NYP430471OtherOXFORD
NY166744OtherHIP