Provider Demographics
NPI:1174580674
Name:KOO, ANDREW (RPA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:KOO
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 8TH AVE
Mailing Address - Street 2:#16D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4838
Mailing Address - Country:US
Mailing Address - Phone:646-533-2045
Mailing Address - Fax:
Practice Address - Street 1:355 8TH AVE
Practice Address - Street 2:#16D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4838
Practice Address - Country:US
Practice Address - Phone:646-533-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program