Provider Demographics
NPI:1154523298
Name:OSIPOV, ANDREI E (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:E
Last Name:OSIPOV
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 1:575 MADISON AVE
Mailing Address - Street 2:10 FLOOR, SUITE 1016
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2511
Mailing Address - Country:US
Mailing Address - Phone:917-892-3529
Mailing Address - Fax:
Practice Address - Street 1:575 MADISON AVE
Practice Address - Street 2:10 FLOOR, SUITE 1016
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2511
Practice Address - Country:US
Practice Address - Phone:917-892-3529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2479722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FO 0894091OtherDEA