# ANDREI TERENTIEV MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164708319
- **Authorized official:** ANDREI TERENTIEV MD (OWNER)
- **Authorized official phone:** (201) 945-4288

## Contact information

- **Practice address:** 103 RIVER RD, SUITE 101, EDGEWATER, NJ 07020-1016
- **Practice address phone:** (201) 945-4288
- **Mailing address:** 103 RIVER RD, SUITE 101, EDGEWATER, NJ 07020-1016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 25MA06075500 | NJ | Yes |

## Other

- **Enumeration date:** 11/01/2011
- **Last updated:** 11/01/2011