Provider Demographics
NPI:1548355977
Name:SATRAN, ANDREW L (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:SATRAN
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 1:228 E ROUTE 59 # 303
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2905
Mailing Address - Country:US
Mailing Address - Phone:718-362-1411
Mailing Address - Fax:718-414-1651
Practice Address - Street 1:358 ROUTE 202, SUITE 2
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:718-362-1411
Practice Address - Fax:718-414-1651
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225466208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02337924Medicaid
NY523X11Medicare ID - Type Unspecified
NY02337924Medicaid