Provider Demographics
NPI:1740778075
Name:EDEN, IDA AHMADIZADEH (MD)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:AHMADIZADEH
Last Name:EDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IDA
Other - Middle Name:
Other - Last Name:AHMADIZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16 E 79TH ST STE 16
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0150
Mailing Address - Country:US
Mailing Address - Phone:465-046-8066
Mailing Address - Fax:
Practice Address - Street 1:16 E 79TH ST STE 16
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0150
Practice Address - Country:US
Practice Address - Phone:465-046-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3001542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry