Provider Demographics
NPI:1588832455
Name:HA, EDWARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:HA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MYUNG
Other - Middle Name:H
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4903 CLOVERDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1420
Mailing Address - Country:US
Mailing Address - Phone:718-359-1144
Mailing Address - Fax:718-359-7946
Practice Address - Street 1:3341 149TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3241
Practice Address - Country:US
Practice Address - Phone:718-359-1144
Practice Address - Fax:718-359-7946
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142074208100000X, 2081N0008X, 2081P2900X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY81365Medicare PIN
NYE69015Medicare UPIN