Provider Demographics
NPI:1114950383
Name:LOIZIDES, EDWARD ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ANDREW
Last Name:LOIZIDES
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 1:332 E MAIN ST
Mailing Address - Street 2:.
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8404
Mailing Address - Country:US
Mailing Address - Phone:163-166-5373
Mailing Address - Fax:631-969-0753
Practice Address - Street 1:332 E MAIN ST
Practice Address - Street 2:.
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8404
Practice Address - Country:US
Practice Address - Phone:631-665-3737
Practice Address - Fax:631-969-0753
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01084211Medicaid
NY01084211Medicaid
NYA61706Medicare UPIN