Provider Demographics
NPI:1528048782
Name:NEOPHYTIDES, ANDREAS (MD)
Entity type:Individual
Prefix:
First Name:ANDREAS
Middle Name:
Last Name:NEOPHYTIDES
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 1:285 RIVERSIDE DR
Mailing Address - Street 2:APT 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5276
Mailing Address - Country:US
Mailing Address - Phone:212-213-9580
Mailing Address - Fax:212-779-9799
Practice Address - Street 1:650 1ST AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3240
Practice Address - Country:US
Practice Address - Phone:212-213-9580
Practice Address - Fax:212-779-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126614174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB80541Medicare UPIN
NY17A971Medicare PIN