Basic Information
| Provider Information | |||||||||
| NPI: | 1659789816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARRISH | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 LYONS AVENUE, SUITE D11 | ||||||||
| Address2: | DEPT OF EMERGENCY MEDICINE | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071122027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739266671 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 LYONS AVENUE, SUITE D11 | ||||||||
| Address2: | DEPT OF EMERGENCY MEDICINE | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071122027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739266671 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2014 | ||||||||
| LastUpdateDate: | 07/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 25MA10065100 | NJ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 25MA10065100 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.