Provider Demographics
NPI:1780759548
Name:VLADIMIR ANDRIES PC
Entity type:Organization
Organization Name:VLADIMIR ANDRIES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANDRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-647-5334
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:WAWARSING
Mailing Address - State:NY
Mailing Address - Zip Code:12489-0375
Mailing Address - Country:US
Mailing Address - Phone:845-647-5334
Mailing Address - Fax:845-294-4333
Practice Address - Street 1:7256 ROUTE 209
Practice Address - Street 2:
Practice Address - City:WAWARSING
Practice Address - State:NY
Practice Address - Zip Code:12489
Practice Address - Country:US
Practice Address - Phone:845-647-5334
Practice Address - Fax:845-294-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY31451OtherPROF SVCS CORP#