Provider Demographics
NPI:1962968313
Name:C. DANDREA MEDICAL
Entity type:Organization
Organization Name:C. DANDREA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-317-4590
Mailing Address - Street 1:150 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2407
Mailing Address - Country:US
Mailing Address - Phone:201-317-4590
Mailing Address - Fax:
Practice Address - Street 1:150 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2407
Practice Address - Country:US
Practice Address - Phone:201-317-4590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1801351622Medicaid
NJ1609118298Medicaid