Healthcare Provider Details

I. General information

NPI: 1568754356
Provider Name (Legal Business Name): ANDREA PODIATRIC CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4604 31ST AVE
LONG ISLAND CITY NY
11103-1842
US

IV. Provider business mailing address

3110 47TH ST
LONG ISLAND CITY NY
11103-1668
US

V. Phone/Fax

Practice location:
  • Phone: 718-990-4620
  • Fax: 718-990-4641
Mailing address:
  • Phone: 718-990-4620
  • Fax: 718-990-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN006076
License Number StateNY

VIII. Authorized Official

Name: DR. MARY ANDREA
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 845-893-4169