Provider Demographics
NPI:1801123617
Name:ANDRADE MEDICAL PLLC
Entity type:Organization
Organization Name:ANDRADE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-650-2775
Mailing Address - Street 1:1163 MANOR AVE FRNT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-3972
Mailing Address - Country:US
Mailing Address - Phone:718-589-3501
Mailing Address - Fax:718-589-1012
Practice Address - Street 1:1163 MANOR AVE FRNT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-3972
Practice Address - Country:US
Practice Address - Phone:718-589-3501
Practice Address - Fax:718-589-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03449401Medicaid
NYP430471OtherOXFORD
NY166744OtherHIP
NY75D981OtherEMPIRE BLUE CROSS BLUE SHIEL
NY1881848422OtherEMPIRE BLUE CROSS BLUE SHIELD
NY1C3448OtherHEALTH NET
NY20388OtherCMO
NY1C3448OtherHEALTH NET
NY20388OtherCMO
NY0009180OtherGHI
NYP430471OtherOXFORD
NY0376636OtherCIGNA