Provider Demographics
NPI:1063065787
Name:EDWARD EZRICK, M.D., P.C.
Entity type:Organization
Organization Name:EDWARD EZRICK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-283-6430
Mailing Address - Street 1:7210 13TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2009
Mailing Address - Country:US
Mailing Address - Phone:718-283-6430
Mailing Address - Fax:718-283-8553
Practice Address - Street 1:7210 13TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2009
Practice Address - Country:US
Practice Address - Phone:718-837-5100
Practice Address - Fax:718-837-7762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty