1467955534 NPI number — MARIA LIZA EDEN GIAMMARIA MD, PLLC

Table of content: (NPI 1467955534)

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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