Provider Demographics
NPI:1992715585
Name:JOSEPH R ANDRADE MD PC
Entity type:Organization
Organization Name:JOSEPH R ANDRADE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-589-3501
Mailing Address - Street 1:131 FOX MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2301
Mailing Address - Country:US
Mailing Address - Phone:718-589-3501
Mailing Address - Fax:
Practice Address - Street 1:1163 MANOR AVE
Practice Address - Street 2:1423 WYTHE PL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-3901
Practice Address - Country:US
Practice Address - Phone:718-589-3501
Practice Address - Fax:718-589-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166744207R00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1C3448OtherHEALTH NET
NY01762454Medicaid
NY0009180OtherGHI
NY0376636OtherCIGNA
NYP430471OtherOXFORD
NY0376636OtherCIGNA
NYA64163Medicare UPIN