Provider Demographics
NPI:1467955534
Name:MARIA LIZA EDEN GIAMMARIA MD, PLLC
Entity Type:Organization
Organization Name:MARIA LIZA EDEN GIAMMARIA MD, PLLC
Other - Org Name:EDEN VASCULAR - NY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LIZA
Authorized Official - Last Name:EDEN-GIAMMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-783-2570
Mailing Address - Street 1:3191 GRAND AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5103
Mailing Address - Country:US
Mailing Address - Phone:646-783-2570
Mailing Address - Fax:646-461-2545
Practice Address - Street 1:20 E 46TH ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9249
Practice Address - Country:US
Practice Address - Phone:646-783-2570
Practice Address - Fax:646-461-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261146-12086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty