Healthcare Provider Details

I. General information

NPI: 1699693218
Provider Name (Legal Business Name): MR. NOAH ANDRIELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 OLD COUNTRY RD STE C103N
WESTBURY NY
11590-5156
US

IV. Provider business mailing address

159 MAIN ST APT 2C
HUNTINGTON NY
11743-6947
US

V. Phone/Fax

Practice location:
  • Phone: 516-806-6969
  • Fax:
Mailing address:
  • Phone: 631-759-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1799518241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: