Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22DI02628400 | NJ |
Y | 1223P0300X | Periodontist | 059422-1 | NY |
N | 1223P0300X | Periodontist | 06701 | NJ |
NPI | 1043678659 |
---|---|
Provider Name | Dr. Andrew Andrawis |
First Address | East Brunswick, NJ 08816-3137 |
Second Address | East Brunswick, NJ 08816-3137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2016 |
Last Update Date | 03/12/2018 |