Healthcare Provider Details

I. General information

NPI: 1942890421
Provider Name (Legal Business Name): ANDY JEON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E 53RD ST
NEW YORK NY
10022-5243
US

IV. Provider business mailing address

7510 GRAND CENTRAL PKWY APT 2B
FOREST HILLS NY
11375-5547
US

V. Phone/Fax

Practice location:
  • Phone: 212-610-0117
  • Fax:
Mailing address:
  • Phone: 617-637-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number06273601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: