MEDICARE: DR. ERIC M ANDOLINA DDS

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	122300000X	Dentist	047131	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

General Provider Information

NPI Number	:	1427039924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC M ANDOLINA DDS

Provider Business Mailing Address
First Line	:	2 GUY PARK AVE
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-4117
Country	:	US
Telephone Number	:	518-842-4430
Fax Number	:	518-842-0593

Provider Business Practice Location Address
First Line	:	2 GUY PARK AVE
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-4117
Country	:	US
Telephone Number	:	518-842-4430
Fax Number	:	518-842-0593

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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