Provider Demographics
NPI:1144740713
Name:EDISON CDPAP LLC
Entity Type:Organization
Organization Name:EDISON CDPAP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-972-2929
Mailing Address - Street 1:946 MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5612
Mailing Address - Country:US
Mailing Address - Phone:7189-722-2929
Mailing Address - Fax:718-972-2323
Practice Address - Street 1:946 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5612
Practice Address - Country:US
Practice Address - Phone:718-972-2929
Practice Address - Fax:718-972-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health