1942252366 NPI number — PHYLLIS ANDREJKO OD

Table of content: PHYLLIS ANDREJKO OD (NPI 1942252366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942252366 NPI number — PHYLLIS ANDREJKO OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREJKO
Provider First Name:
PHYLLIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942252366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 COMMONWEALTH AVE
Provider Second Line Business Mailing Address:
NEW ENGLAND EYE INSTITUTE
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-587-5511
Provider Business Mailing Address Fax Number:
617-587-5512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4199 WASHINGTON STREET, SUITE 2
Provider Second Line Business Practice Location Address:
NEW ENGLAND EYE ROSLINDALE
Provider Business Practice Location Address City Name:
ROSLINDALE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-587-5520
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4021 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0708381 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152186 . This is a "HARVARD PILGRIM HEALTH CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 467450 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA119306 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2008451 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2500346 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA4021 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: W16351 . This is a "BLUE CROSS BLUE SHIELD OF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0018540 . This is a "NHP" identifier . This identifiers is of the category "OTHER".




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