Provider Demographics
NPI:1336968791
Name:ELECTRODIAGNOSTIC AND PHYSICAL MEDICINE P.C.
Entity type:Organization
Organization Name:ELECTRODIAGNOSTIC AND PHYSICAL MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DANIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-281-3016
Mailing Address - Street 1:5822 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2454
Mailing Address - Country:US
Mailing Address - Phone:718-549-3185
Mailing Address - Fax:718-884-5002
Practice Address - Street 1:5822 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2454
Practice Address - Country:US
Practice Address - Phone:718-549-3185
Practice Address - Fax:718-884-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty