Healthcare Provider Details

I. General information

NPI: 1417287707
Provider Name (Legal Business Name): PETER ANDRADE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3371 RICHMOND AVE
STATEN ISLAND NY
10312-2025
US

IV. Provider business mailing address

265 WATER ST APT 4
NEW YORK NY
10038-1718
US

V. Phone/Fax

Practice location:
  • Phone: 929-229-7139
  • Fax: 929-229-7139
Mailing address:
  • Phone: 954-234-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB10124900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number293510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: