Provider Demographics
NPI:1336242478
Name:ANDONAKAKIS, ANGELO (DO)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:ANDONAKAKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:EVANGELOS
Other - Middle Name:
Other - Last Name:ANDONAKAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40 FRONT ST STE C
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4712
Mailing Address - Country:US
Mailing Address - Phone:607-722-7264
Mailing Address - Fax:
Practice Address - Street 1:LOURDES HOSPITAL
Practice Address - Street 2:169 RIVERSIDE DRIVE
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-722-7264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10055600207L00000X
PAOS008310L207L00000X
NY326268207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001673318Medicaid
NJ7393504Medicaid
PA001673318Medicaid