=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477610137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREW J. SZABO, MD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 06/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 860 5TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-5856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-583-2816
-----------------------------------------------------
Fax | 212-734-0382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 860 5TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-5856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-583-2816
-----------------------------------------------------
Fax | 212-734-0382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. ANDREW JOHN SZABO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-583-2816
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 095936
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------