Provider Demographics
NPI:1912089277
Name:VIDALI, ANDREA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:VIDALI
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 1:800 WOODBURY RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2503
Mailing Address - Country:US
Mailing Address - Phone:516-584-8710
Mailing Address - Fax:516-584-8711
Practice Address - Street 1:800 WOODBURY RD
Practice Address - Street 2:SUITE G
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2503
Practice Address - Country:US
Practice Address - Phone:516-584-8710
Practice Address - Fax:516-584-8711
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195356-1207VE0102X
NJ615527207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F82855Medicare UPIN