Provider Demographics
NPI:1104090539
Name:ELBARDISSI, ANDREW WAHIB (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:WAHIB
Last Name:ELBARDISSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 POWDER HILL LN
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-5129
Mailing Address - Country:US
Mailing Address - Phone:215-859-2320
Mailing Address - Fax:
Practice Address - Street 1:19 POWDER HILL LN
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-5129
Practice Address - Country:US
Practice Address - Phone:215-859-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259862086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery