1467955534 NPI number — MARIA LIZA EDEN GIAMMARIA MD, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467955534 NPI number — MARIA LIZA EDEN GIAMMARIA MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA LIZA EDEN GIAMMARIA MD, PLLC
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:
6
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:
1467955534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3191 GRAND AVE STE 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33133-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-783-2570
Provider Business Mailing Address Fax Number:
646-461-2545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 E 46TH ST FL 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017-9249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-783-2570
Provider Business Practice Location Address Fax Number:
646-461-2545
Provider Enumeration Date:
03/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
EDEN-GIAMMARIA
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
LIZA
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
646-783-2570

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  261146-1 , 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)





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