Provider Demographics
NPI:1770519977
Name:ZAAGER, ANDREW RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RICHARD
Last Name:ZAAGER
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 1:630 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4909
Mailing Address - Country:US
Mailing Address - Phone:516-937-1121
Mailing Address - Fax:516-937-1126
Practice Address - Street 1:630 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4909
Practice Address - Country:US
Practice Address - Phone:516-937-1121
Practice Address - Fax:516-937-1126
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-00955207R00000X
SC83125207R00000X
TXS4251207R00000X
NY155654207R00000X
ARE-12049207R00000X
GA82305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63677Medicare UPIN
NY66D341Medicare ID - Type Unspecified