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General NPI Number Information
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NPI Number | 1942252366
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Entity Type | Individual
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Provider Name | PHYLLIS ANDREJKO OD
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 4199 WASHINGTON STREET, SUITE 2 NEW ENGLAND EYE ROSLINDALE
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City | ROSLINDALE
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State | MA
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Zip | 02131
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Country | US
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Telephone | 617-587-5520
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Fax |
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Provider Business Mailing Address
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Address Line | 940 COMMONWEALTH AVE NEW ENGLAND EYE INSTITUTE
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City | BOSTON
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State | MA
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Zip | 02215
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Country | US
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Telephone | 617-587-5511
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Fax | 617-587-5512
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4021
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License Number State | MA
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