Healthcare Provider Details

I. General information

NPI: 1316937493
Provider Name (Legal Business Name): ANDREA MARIE WARD DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 116TH ST
NEW YORK NY
10026-2416
US

IV. Provider business mailing address

1374 MAIN ST
STRATFORD CT
06615-7021
US

V. Phone/Fax

Practice location:
  • Phone: 212-222-7800
  • Fax: 212-222-7955
Mailing address:
  • Phone: 203-385-8595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: