Provider Demographics
NPI:1770710923
Name:LENDARIS, ANDREA R (MD, MS)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:R
Last Name:LENDARIS
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:R
Other - Last Name:PENSABENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 E 66TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6405
Mailing Address - Country:US
Mailing Address - Phone:917-536-3397
Mailing Address - Fax:
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016360235Z00000X
NY390200000X
NY3166592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1770710923Medicaid