Provider Demographics
NPI:1053566000
Name:MICHAEL P. ANDRONICO, PH.D., P.C.
Entity type:Organization
Organization Name:MICHAEL P. ANDRONICO, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANDRONICO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-564-9500
Mailing Address - Street 1:107 CEDAR GROVE LN
Mailing Address - Street 2:SUITE 103 G
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4719
Mailing Address - Country:US
Mailing Address - Phone:732-564-9500
Mailing Address - Fax:732-564-9501
Practice Address - Street 1:107 CEDAR GROVE LN
Practice Address - Street 2:SUITE 103 G
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4719
Practice Address - Country:US
Practice Address - Phone:732-564-9500
Practice Address - Fax:732-564-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100065500103T00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
081177Medicare PIN
NJ168859SX2Medicare PIN