Provider Demographics
NPI:1679534416
Name:ANDREW MG DAVY, MD PC
Entity type:Organization
Organization Name:ANDREW MG DAVY, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MG
Authorized Official - Last Name:DAVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-596-2824
Mailing Address - Street 1:71 S ORANGE AVE
Mailing Address - Street 2:#314
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1715
Mailing Address - Country:US
Mailing Address - Phone:718-596-2824
Mailing Address - Fax:718-596-2867
Practice Address - Street 1:1513 VOORHIES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3994
Practice Address - Country:US
Practice Address - Phone:718-596-2824
Practice Address - Fax:718-596-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEV511Medicare PIN