MEDICARE: DR. AVIVA LOUISE ANDREEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DI2246300	NJ
2	122300000X	Dentist	047965	NY

General Provider Information

NPI Number	:	1831180512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVIVA LOUISE ANDREEN DDS

Provider Business Mailing Address
First Line	:	1273 NORTH AVE
Second Line	:	BLDG 3 APT 4A5
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-2702
Country	:	US
Telephone Number	:	646-245-3790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1273 NORTH AVE
Second Line	:	BLDG 3 APT 4A5
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-2702
Country	:	US
Telephone Number	:	646-245-3790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/08/2008

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