Provider Demographics
NPI:1922513241
Name:EDEN VASCULAR AND VEINS-FL
Entity Type:Organization
Organization Name:EDEN VASCULAR AND VEINS-FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEN GIAMMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-783-2570
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:
Practice Address - Street 1:101 JFK DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1119
Practice Address - Country:US
Practice Address - Phone:561-357-2020
Practice Address - Fax:561-357-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108323202K00000X, 208600000X, 246XC2903X
NY261146-1202K00000X, 208600000X, 246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty