Provider Demographics
NPI:1053675306
Name:STIGA, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:STIGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20417 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1106
Mailing Address - Country:US
Mailing Address - Phone:917-405-9176
Mailing Address - Fax:718-474-6914
Practice Address - Street 1:20417 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY POINT
Practice Address - State:NY
Practice Address - Zip Code:11697-1106
Practice Address - Country:US
Practice Address - Phone:917-405-9176
Practice Address - Fax:718-474-6914
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator