Provider Demographics
NPI:1891839312
Name:FEDIDA, ANDRE ARMAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:ARMAND
Last Name:FEDIDA
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 1:306 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2011
Mailing Address - Country:US
Mailing Address - Phone:973-877-2580
Mailing Address - Fax:973-877-2578
Practice Address - Street 1:306 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2011
Practice Address - Country:US
Practice Address - Phone:973-877-2580
Practice Address - Fax:973-877-2578
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA054073207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5049504Medicaid
NJE83383Medicare UPIN
NJ5049504Medicaid