Provider Demographics
NPI:1235195876
Name:WOOD, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-8354
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:11120 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-4016
Practice Address - Country:US
Practice Address - Phone:718-206-9888
Practice Address - Fax:718-206-3033
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY083375207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C07470Medicare UPIN
NY0359EKMedicare ID - Type Unspecified