Provider Demographics
NPI:1508982836
Name:EDWARD MORREALE DPM PC
Entity Type:Organization
Organization Name:EDWARD MORREALE DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-437-9343
Mailing Address - Street 1:405 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3107
Mailing Address - Country:US
Mailing Address - Phone:718-437-9343
Mailing Address - Fax:718-633-7352
Practice Address - Street 1:405 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3107
Practice Address - Country:US
Practice Address - Phone:718-437-9343
Practice Address - Fax:718-633-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005019213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01475332Medicaid
NY6210730001Medicare NSC
NYU36890Medicare UPIN
NYP60282Medicare ID - Type Unspecified