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General NPI Number Information
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NPI Number | 1669536058
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Entity Type | Organization
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Legal Business Name | ANDREA P THAU
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 77 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10016-2556
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Country | US
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Telephone | 212-685-2457
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Fax |
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Provider Business Mailing Address
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Address Line | 77 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10016-2556
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Country | US
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Telephone | 212-685-2457
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ANDREA P THAU
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Credential | OD
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Telephone | 212-685-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | VUT4479
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License Number State | NY
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