Provider Demographics
NPI:1467620559
Name:EMEDO, EVEREST U
Entity Type:Individual
Prefix:
First Name:EVEREST
Middle Name:U
Last Name:EMEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BEACH 29TH ST
Mailing Address - Street 2:2
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2093
Mailing Address - Country:US
Mailing Address - Phone:347-926-4003
Mailing Address - Fax:
Practice Address - Street 1:215 BEACH 29TH ST
Practice Address - Street 2:2
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2093
Practice Address - Country:US
Practice Address - Phone:347-926-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285388164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse