Healthcare Provider Details

I. General information

NPI: 1861298572
Provider Name (Legal Business Name): ANDREW FREEMAN AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3074 31ST ST FL 2
ASTORIA NY
11102-2073
US

IV. Provider business mailing address

3074 31ST ST FL 2
ASTORIA NY
11102-2073
US

V. Phone/Fax

Practice location:
  • Phone: 718-989-8515
  • Fax: 718-626-0102
Mailing address:
  • Phone: 718-989-8515
  • Fax: 718-626-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF433231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: