Provider Demographics
NPI:1558371724
Name:OSTAD, EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:OSTAD
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:PO BOX 720066
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-0066
Mailing Address - Country:US
Mailing Address - Phone:718-505-1177
Mailing Address - Fax:718-505-2046
Practice Address - Street 1:3739 75TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6422
Practice Address - Country:US
Practice Address - Phone:718-505-1177
Practice Address - Fax:718-505-2046
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222576208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02549535Medicaid
NY04373HMedicare PIN
NY02549535Medicaid
NYA400105439Medicare PIN