Provider Demographics
NPI:1891757274
Name:DAVY, ANDREW MG (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MG
Last Name:DAVY
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 1:71 S ORANGE AVE
Mailing Address - Street 2:#314
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1715
Mailing Address - Country:US
Mailing Address - Phone:718-377-8877
Mailing Address - Fax:718-377-1192
Practice Address - Street 1:1513 VOORHIES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3994
Practice Address - Country:US
Practice Address - Phone:718-377-8877
Practice Address - Fax:718-377-1192
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189163207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01A12EV511Medicare PIN
NYF83279Medicare UPIN
NY01A123Medicare PIN