Provider Demographics
NPI:1205878121
Name:HONIG, EDEN (DO)
Entity type:Individual
Prefix:DR
First Name:EDEN
Middle Name:
Last Name:HONIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1623
Mailing Address - Country:US
Mailing Address - Phone:718-347-0494
Mailing Address - Fax:718-347-6793
Practice Address - Street 1:6 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2108
Practice Address - Country:US
Practice Address - Phone:718-347-0494
Practice Address - Fax:718-347-6793
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02590045Medicaid
NY02590045Medicaid