Provider Demographics
NPI:1194738898
Name:EDAYADI, ALEXANDER P (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:P
Last Name:EDAYADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2901
Mailing Address - Country:US
Mailing Address - Phone:516-502-6699
Mailing Address - Fax:
Practice Address - Street 1:1735 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2901
Practice Address - Country:US
Practice Address - Phone:516-502-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY153SA1Medicare ID - Type UnspecifiedEMPIRE
NYI42519Medicare UPIN