Healthcare Provider Details

I. General information

NPI: 1235471616
Provider Name (Legal Business Name): ANDREW PIETRIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MERRITT BLVD SUITE 106
FISHKILL NY
12524-2917
US

IV. Provider business mailing address

60 MERRITT BLVD SUITE 106
FISHKILL NY
12524-2917
US

V. Phone/Fax

Practice location:
  • Phone: 845-202-7182
  • Fax: 845-202-7185
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number016817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: