Provider Demographics
NPI:1669550687
Name:BLACK, ANDREW D (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:629 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3354
Mailing Address - Country:US
Mailing Address - Phone:718-756-6200
Mailing Address - Fax:718-756-6204
Practice Address - Street 1:629 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3354
Practice Address - Country:US
Practice Address - Phone:718-756-6200
Practice Address - Fax:718-756-6204
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY143801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78332Medicare UPIN