Provider Demographics
NPI: | 1851528616 |
---|---|
Name: | EDEN GIAMMARIA, MARIA LIZA (MD, MPH, FACPH) |
Entity Type: | Individual |
Prefix: | |
First Name: | MARIA LIZA |
Middle Name: | |
Last Name: | EDEN GIAMMARIA |
Suffix: | |
Gender: | F |
Credentials: | MD, MPH, FACPH |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 330030 |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33233-0030 |
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: | 646-219-0082 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2009-06-18 |
Last Update Date: | 2018-03-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME108323 | 202K00000X, 2083S0010X, 208600000X |
NJ | 25MA09058000 | 2083S0010X, 208600000X, 202K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 202K00000X | Allopathic & Osteopathic Physicians | Phlebology | |
No | 2083S0010X | Allopathic & Osteopathic Physicians | Preventive Medicine | Sports Medicine |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery |