Healthcare Provider Details

I. General information

NPI: 1043567159
Provider Name (Legal Business Name): MR. ANDREW RICHARD DA SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 AVENUE X
BROOKLYN NY
11223-5960
US

IV. Provider business mailing address

210 HUMBOLDT ST APT. 29
BROOKLYN NY
11206
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-6200
  • Fax:
Mailing address:
  • Phone: 845-551-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number086625-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: