Individual
ANDREW IVANSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
726 AVENUE Z, BROOKLYN, NY 11223-6238
(718) 872-7373
Mailing address
4817 BEDFORD AVE, 3A, BROOKLYN, NY 11235-2783
(646) 541-9779
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
209134
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01936034
—
NY
Enumeration date
06/04/2006
Last updated
07/08/2007
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