Provider Demographics
NPI:1457437881
Name:PERSAUD, ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:PERSAUD
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 1:620 E BOSTON POST RD
Mailing Address - Street 2:620 EAST BOSTON POST ROAD
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3741
Mailing Address - Country:US
Mailing Address - Phone:914-777-5437
Mailing Address - Fax:914-630-0907
Practice Address - Street 1:620 E BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3741
Practice Address - Country:US
Practice Address - Phone:914-777-5437
Practice Address - Fax:914-630-0907
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY24556982080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2494046Medicaid
OH2494046Medicaid
I10935Medicare UPIN