Provider Demographics
NPI:1730323692
Name:ANDERSON, DAVID FARRELL
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FARRELL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14907 SANFORD AVE
Mailing Address - Street 2:#1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1050
Mailing Address - Country:US
Mailing Address - Phone:718-321-1012
Mailing Address - Fax:
Practice Address - Street 1:14907 SANFORD AVE
Practice Address - Street 2:#1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1050
Practice Address - Country:US
Practice Address - Phone:718-321-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0152292251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics