Provider Demographics
NPI:1720285083
Name:ANDRIOLA, VIRGINIA PAULA V (RN)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:PAULA
Last Name:ANDRIOLA
Suffix:V
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FOUNTAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1433
Mailing Address - Country:US
Mailing Address - Phone:914-946-8309
Mailing Address - Fax:
Practice Address - Street 1:21 FOUNTAIN DR
Practice Address - Street 2:901 KNOLLWOOD ROAD GREENBURGH NEW YORK
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1433
Practice Address - Country:US
Practice Address - Phone:914-946-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251447-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02211627Medicaid