Healthcare Provider Details

I. General information

NPI: 1114972718
Provider Name (Legal Business Name): ANDREW C PRZYBYLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CRAFTON AVE
STATEN ISLAND NY
10314
US

IV. Provider business mailing address

5 CRAFTON AVE
STATEN ISLAND NY
10314
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-2220
  • Fax: 718-698-2220
Mailing address:
  • Phone: 718-698-2220
  • Fax: 718-698-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number106073
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: