1336264118 NPI number — LINDA EDNALINO MD PC

Table of content: (NPI 1336264118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336264118 NPI number — LINDA EDNALINO MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA EDNALINO MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336264118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
849 MOORE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODMERE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11598-2315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9015 ROCKAWAY BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKAWAY BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11693-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-241-1513
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDNALINO
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-255-2333

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  153923 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00803443 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0521971 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 45100P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 253AR1 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P400951 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 153923-C24 . This is a "HEALTH FIRST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5C4831 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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