Provider Demographics
NPI:1891924064
Name:KIRK, ANDREW B (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:KIRK
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 NORTH BROADWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1310
Mailing Address - Country:US
Mailing Address - Phone:914-476-4343
Mailing Address - Fax:914-963-6426
Practice Address - Street 1:970 NORTH BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1310
Practice Address - Country:US
Practice Address - Phone:914-476-4343
Practice Address - Fax:914-963-6426
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013305363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03778Medicare PIN
NYWZWYR1Medicare PIN