Active NPI
Andrew Wahib Elbardissi, MD
- Vascular Surgery Physician
- East Hampton, NY
National Provider Identifier
1104090539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 25986
- Practice address
- 19 Powder Hill LN
East Hampton, NY 11937-5129 - Phone
- (215) 859-2320
- NPI assigned
- Apr 16, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 25986 | NY | Primary |
Addresses
Primary practice location
19 Powder Hill LN
East Hampton, NY 11937-5129
Mailing address
19 Powder Hill LN
East Hampton, NY 11937-5129
Phone (215) 859-2320
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25986 | NY | MD | Vascular Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703808000000",
"number": "1104090539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 POWDER HILL LN",
"city": "EAST HAMPTON",
"state": "NY",
"postal_code": "119375129",
"telephone_number": "215-859-2320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 POWDER HILL LN",
"city": "EAST HAMPTON",
"state": "NY",
"postal_code": "119375129",
"telephone_number": "215-859-2320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELBARDISSI",
"first_name": "ANDREW",
"middle_name": "WAHIB",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-16",
"last_updated": "2023-12-29",
"certification_date": "2023-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "NY",
"license": "25986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Hampton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.