Provider Demographics
NPI:1851528616
Name:EDEN GIAMMARIA, MARIA LIZA (MD, MPH, FACPH)
Entity type:Individual
Prefix:
First Name:MARIA LIZA
Middle Name:
Last Name:EDEN GIAMMARIA
Suffix:
Gender:F
Credentials:MD, MPH, FACPH
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 330030
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33233-0030
Mailing Address - Country:US
Mailing Address - Phone:646-783-2570
Mailing Address - Fax:646-461-2545
Practice Address - Street 1:20 E 46TH ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9249
Practice Address - Country:US
Practice Address - Phone:646-783-2570
Practice Address - Fax:646-219-0082
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108323202K00000X, 2083S0010X, 208600000X
NJ25MA090580002083S0010X, 208600000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery