MEDICARE: ANDREW WAHIB ELBARDISSI MD

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	2086S0129X	Vascular Surgery Physician	25986	NY

General Provider Information

NPI Number	:	1104090539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW WAHIB ELBARDISSI MD

Provider Business Mailing Address
First Line	:	19 POWDER HILL LN
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-5129
Country	:	US
Telephone Number	:	215-859-2320
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 POWDER HILL LN
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-5129
Country	:	US
Telephone Number	:	215-859-2320
Fax Number	:

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	12/29/2023

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