Individual
ANDY JAGODA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100TH STREET AND MADISON AVE, NEW YORK, NY 10029
(212) 241-0101
(212) 426-5083
Mailing address
170 EAST 87TH ST, STE W20C, NEW YORK, NY 10128
(212) 241-0101
(212) 426-5083
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2006931
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01390752
—
NY
01
—
930061988
RR MEDICARE
NY
Enumeration date
03/08/2006
Last updated
07/10/2008
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