Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 57082 | CT |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036138010 | IL |
NPI | 1114247798 |
---|---|
Provider Name | Dr. Kenneth J. Andrews |
First Address | Rocky Hill, CT 06067-2313 |
Second Address | New Britain, CT 06052-1321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 17/03/2018 |