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General NPI Number Information
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NPI Number | 1417287707
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Entity Type | Individual
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Provider Name | PETER ANDRADE D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 3371 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2025
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Country | US
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Telephone | 929-229-7139
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Fax | 929-229-7139
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Provider Business Mailing Address
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Address Line | 265 WATER ST APT 4
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City | NEW YORK
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State | NY
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Zip | 10038-1718
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Country | US
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Telephone | 954-234-3811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MB10124900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 293510
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License Number State | NY
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