Provider Demographics
NPI:1437468014
Name:ANDREW C. PRZYBYLA, MD,PC
Entity type:Organization
Organization Name:ANDREW C. PRZYBYLA, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRZYBYLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-698-2220
Mailing Address - Street 1:5 CRAFTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6801
Mailing Address - Country:US
Mailing Address - Phone:718-698-2220
Mailing Address - Fax:718-698-2220
Practice Address - Street 1:5 CRAFTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6801
Practice Address - Country:US
Practice Address - Phone:718-698-2220
Practice Address - Fax:718-698-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106073207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB20346Medicare UPIN
NY952361Medicare PIN