Healthcare Provider Details

I. General information

NPI: 1538224662
Provider Name (Legal Business Name): ANDREA GEFELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA PILAR GONZALEZ PA

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 DRIVING PARK AVE
NEWARK NY
14513-1057
US

IV. Provider business mailing address

1208 DRIVING PARK AVE
NEWARK NY
14513-1057
US

V. Phone/Fax

Practice location:
  • Phone: 315-359-2640
  • Fax:
Mailing address:
  • Phone: 315-359-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number011803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: