Healthcare Provider Details

I. General information

NPI: 1962458133
Provider Name (Legal Business Name): ANDREA DOBRENIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST J-130
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

425 E 61ST ST FL 11
NEW YORK NY
10065-8722
US

V. Phone/Fax

Practice location:
  • Phone: 212-821-0907
  • Fax:
Mailing address:
  • Phone: 212-821-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number187515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: