Provider Demographics
NPI:1811977762
Name:ANDRON, RICHARD ISRAEL (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ISRAEL
Last Name:ANDRON
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 1:106 GRAND AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3596
Mailing Address - Country:US
Mailing Address - Phone:201-871-1515
Mailing Address - Fax:201-871-9683
Practice Address - Street 1:106 GRAND AVE STE 450
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-871-1515
Practice Address - Fax:201-871-9683
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130691207R00000X
NJ35880207R00000X
NJ59298207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11A79OtherEMPIRE BCBS
223516244OtherGREAT WEST
223516244OtherHORIZON PCP ALL PLANS
223516244OtherPHCS
4383535OtherAETNA PPO
5950399009OtherCIGNA SPEC
223516244OtherMEDICHOICE
NJ2976901OtherMEDICAID SECONDARY TO MED
5950399007OtherCIGNA PCP
BP179OtherOXFORD
0494571001OtherAMERIHEALTH
223516244OtherHORIZON SPEC PPO ONLY
009397OtherONE HEALTH PLAN GREAT WES
223516244OtherMAGNACARE
OK5421OtherHNET
223516244OtherUNITED HEALTH CARE
OK5421OtherHEALTHNET GUARDIAN
4383535OtherAETNA PPO
5950399007OtherCIGNA PCP
C56208Medicare UPIN