Provider Demographics
NPI:1376579938
Name:REDA, EDWARD F (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:F
Last Name:REDA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:247 ROUTE 100
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-3231
Mailing Address - Country:US
Mailing Address - Phone:914-962-8290
Mailing Address - Fax:914-962-8851
Practice Address - Street 1:150 WHITE PLAINS RD
Practice Address - Street 2:SUITE 306
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5535
Practice Address - Country:US
Practice Address - Phone:914-493-8628
Practice Address - Fax:914-493-8564
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2014-01-29
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Provider Licenses
StateLicense IDTaxonomies
NY1496882088P0231X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00715586Medicaid
NY00715586Medicaid
A64030Medicare UPIN