Provider Demographics
NPI:1285758896
Name:ADAMO, ANDREA JOYCE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JOYCE
Last Name:ADAMO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:JOYCE
Other - Last Name:BALKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9 NORTHFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-676-9162
Mailing Address - Fax:
Practice Address - Street 1:9 NORTHFIELD ROAD
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-676-9162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1529581163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01459425Medicaid
NY1529581OtherRN