Provider Demographics
NPI:1669536058
Name:ANDREA P THAU
Entity type:Organization
Organization Name:ANDREA P THAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:P
Authorized Official - Last Name:THAU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-685-2457
Mailing Address - Street 1:77 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2556
Mailing Address - Country:US
Mailing Address - Phone:212-685-2457
Mailing Address - Fax:
Practice Address - Street 1:77 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2556
Practice Address - Country:US
Practice Address - Phone:212-685-2457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT4479152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC32391Medicare PIN
NYT4940Medicare UPIN