Provider Demographics
NPI:1154411122
Name:POTASH, ANDREW I (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:POTASH
Suffix:I
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1078
Mailing Address - Country:US
Mailing Address - Phone:732-238-1883
Mailing Address - Fax:732-238-1890
Practice Address - Street 1:811 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1078
Practice Address - Country:US
Practice Address - Phone:732-238-1883
Practice Address - Fax:732-238-1890
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPO500333Medicare ID - Type Unspecified
NJU63988Medicare UPIN