Healthcare Provider Details

I. General information

NPI: 1659429702
Provider Name (Legal Business Name): ANDREA J ATTARDO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 ROUTE 17M
CHESTER NY
10918-1054
US

IV. Provider business mailing address

2 COATES DR
GOSHEN NY
10924-6758
US

V. Phone/Fax

Practice location:
  • Phone: 845-469-4211
  • Fax: 845-469-2339
Mailing address:
  • Phone: 845-651-1412
  • Fax: 845-651-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: