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Individual

DR. PETER ANDRADE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
3371 RICHMOND AVE, STATEN ISLAND, NY 10312-2025
(929) 229-7139
(929) 229-7139
Mailing address
265 WATER ST APT 4, NEW YORK, NY 10038-1718
(954) 234-3811

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
293510
NY
208600000X
Surgery Physician
25MB10124900
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12785099
CAQH
01
1417287707
NPI
01
1588246433
NPI
01
1780276816
NPI
01
25MB10124900
NJ MEDICAL LICENSE
NJ
01
293510
NY MED LICENSE
NY
01
7430432372
NRCME
Enumeration date
01/08/2010
Last updated
01/03/2023
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