Provider Demographics
NPI:1457613051
Name:ANDRUSIER, ANITA
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:ANDRUSIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 RICHMOND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3913
Mailing Address - Country:US
Mailing Address - Phone:718-851-3300
Mailing Address - Fax:718-370-1597
Practice Address - Street 1:1911 RICHMOND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3913
Practice Address - Country:US
Practice Address - Phone:718-851-3300
Practice Address - Fax:718-370-1597
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator