MEDICARE: DR. PETER ANTHONY ANDOLINA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	0300434	NY
2	208200000X	Plastic Surgery Physician	269587	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073893822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ANTHONY ANDOLINA D.O.

Provider Business Mailing Address
First Line	:	53 W 36TH ST RM 204
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-7624
Country	:	US
Telephone Number	:	212-500-2163
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 W 36TH ST RM 204
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-7624
Country	:	US
Telephone Number	:	212-500-2163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	12/10/2024

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