Provider Demographics
NPI:1124287297
Name:ANDIORIO, JOHN L (M ED BCIAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:ANDIORIO
Suffix:
Gender:M
Credentials:M ED BCIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 NEW YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2101
Mailing Address - Country:US
Mailing Address - Phone:732-974-3000
Mailing Address - Fax:732-974-3001
Practice Address - Street 1:221 NEW YORK BLVD
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-2101
Practice Address - Country:US
Practice Address - Phone:732-974-3000
Practice Address - Fax:732-974-3001
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist