Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 275487 | NY |
N | 111NI0900X | Internist | 275487 | NY |
Y | 207RA0401X | Internist - Addiction Medicine | 275487 | NY |
NPI | 1083021133 |
---|---|
Provider Name | Dr. Andrea Kermack |
First Address | Bronx, NY 10039 |
Second Address | Bronx, NY 10039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2014 |
Last Update Date | 03/05/2021 |