Healthcare Provider Details

I. General information

NPI: 1912089277
Provider Name (Legal Business Name): ANDREA VIDALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PINELAWN ROAD SUITE 115 SOUTH
MELVILLE NY
11747-3198
US

IV. Provider business mailing address

135 PINELAWN ROAD SUITE 115 SOUTH
MELVILLE NY
11747-3198
US

V. Phone/Fax

Practice location:
  • Phone: 516-584-8710
  • Fax: 516-584-8711
Mailing address:
  • Phone: 516-584-8710
  • Fax: 516-584-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number195356-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number615527
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: