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General NPI Number Information
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NPI Number | 1003350562
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Entity Type | Organization
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Legal Business Name | ANDRUS
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 126 WASHINGTON AVE
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City | SUFFERN
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State | NY
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Zip | 10901-6246
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Country | US
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Telephone | 845-918-1273
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Fax |
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Provider Business Mailing Address
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Address Line | 126 WASHINGTON AVE
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City | SUFFERN
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State | NY
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Zip | 10901-6246
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Country | US
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Telephone | 845-918-1273
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Fax |
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Authorized Official
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Title or Position | RN
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Name | VALERIE A DESIMONE
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Credential |
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Telephone | 845-918-1273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 559935-1
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License Number State | NY
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