=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821061490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW H EICHENFIELD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2006
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 728 N MAIN ST
-----------------------------------------------------
City | NEW SQUARE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10977-8916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-356-3610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 402 E 90TH ST APT 6A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-289-0359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0216X
-----------------------------------------------------
Taxonomy Name | Pediatric Rheumatology Physician
-----------------------------------------------------
License Number | 144443
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------