=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982383725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDRADE ACCESS MEDICAL SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2023
-----------------------------------------------------
Last Update Date | 07/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4446 BROADWAY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10040-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-808-2825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 EAST HARTSDALE AVE. SUITE 3PE
-----------------------------------------------------
City | HARTSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10530-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-808-2825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSEPH R ANDRADE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-808-2825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------