Look up the most recent NPI and PECOS records

Andrew Wackett

Emergency Medicine

Allopathic & Osteopathic Physicians

University Hospital, L4, Stony Brook, NY 11794-0001

PECOS Enrollment

Based on the most recent information from CMS, provider Andrew Wackett is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1649215740
Provider Type
Individual
Full Name
Wackett, Andrew
Title
Dr.

Credential
M.D.
Gender
Male
Enumeration Date
6/20/2006
Last Updated
7/8/2007

Contact Information

Practice Location

University Hospital, L4, Stony Brook, NY 11794-0001

(631) 444-2499

Unlisted Fax

Mailing Location

PO Box 1559, Stony Brook, NY 11790-0989

(631) 444-2499

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License 213860 New York

Provider Identifiers

ID	Description	Issuer
ID 7074586	Description Other	Issuer AETNA New York
ID 62Q082	Description Other	Issuer EMPIRE BC.BS New York
ID 02108478	Description Medicaid	Issuer Unlisted New York

Andrew Wackett

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

English, Bryan Patrick

Cox, Lincoln

Scott, Hayley Morgan

Ahn, Christine Sunjung

Garra, Gregory

Leibowitz, Jillian Ashley

Morley, Eric J

Singer, Daniel D

Deassis, Jonathan Austin

Thompson, Crystal Nicole