Provider Demographics
NPI:1427887652
Name:DENIMARCK, ANDREA SUZANNE
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:SUZANNE
Last Name:DENIMARCK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:SUZANNE
Other - Last Name:TOFALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4037 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2265
Mailing Address - Country:US
Mailing Address - Phone:516-978-1592
Mailing Address - Fax:
Practice Address - Street 1:4037 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2265
Practice Address - Country:US
Practice Address - Phone:516-978-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist