Provider Demographics
NPI:1972165918
Name:VAN SCOYK, ANDREW JEFFRY (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JEFFRY
Last Name:VAN SCOYK
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 1:508 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7837
Mailing Address - Country:US
Mailing Address - Phone:860-378-2891
Mailing Address - Fax:
Practice Address - Street 1:508 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-7837
Practice Address - Country:US
Practice Address - Phone:860-378-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81105207Q00000X, 207R00000X
IL125.075219207Q00000X
CODR.0069067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000207818Medicaid