Provider Demographics
NPI:1538273354
Name:FRANK, ANDREA J (D O P C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:FRANK
Suffix:
Gender:F
Credentials:D O P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700N HABANA AVE 700
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7122
Mailing Address - Country:US
Mailing Address - Phone:813-763-1151
Mailing Address - Fax:
Practice Address - Street 1:66 S 21ST ST
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1626
Practice Address - Country:US
Practice Address - Phone:908-276-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB50885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0K8035OtherHEALTH NET
UP079OtherOXFORD
NJ0067563Medicaid
CK2496OtherRAILROAD MEDICARE
0281079001OtherAMERIHEALTH
0281079001OtherAMERICHOICE
6100225OtherGHI
E53076Medicare UPIN
NJ0067563Medicaid