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Individual

JOHN A ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
213 BROADWAY, PORT EWEN, NY 12466-7769
(845) 331-2355
(845) 331-1184
Mailing address
279 MAIN ST, SUITE 204, NEW PALTZ, NY 12561-1623
(845) 255-3046
(845) 255-0236

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
153823
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00849270
NY
Enumeration date
05/24/2006
Last updated
11/11/2014
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