Provider Demographics
NPI:1104990035
Name:ANDREWS, ALAN DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DOUGLAS
Last Name:ANDREWS
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 1:7332 CENROSE CIR
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2457
Mailing Address - Country:US
Mailing Address - Phone:201-722-0707
Mailing Address - Fax:
Practice Address - Street 1:500 PIERMONT RD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2845
Practice Address - Country:US
Practice Address - Phone:201-767-0501
Practice Address - Fax:201-767-7904
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04601400207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3705609Medicaid
NJ3705609Medicaid
NJ509328Medicare ID - Type Unspecified