Provider Demographics
NPI:1104231125
Name:REGISTRE, EDNER (DPM)
Entity type:Individual
Prefix:MR
First Name:EDNER
Middle Name:
Last Name:REGISTRE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 ROQUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1209
Mailing Address - Country:US
Mailing Address - Phone:347-679-5443
Mailing Address - Fax:
Practice Address - Street 1:11572 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1028
Practice Address - Country:US
Practice Address - Phone:718-276-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006837213E00000X
NYR93136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist