Provider Demographics
NPI:1336264118
Name:LINDA EDNALINO MD PC
Entity Type:Organization
Organization Name:LINDA EDNALINO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDNALINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-255-2333
Mailing Address - Street 1:849 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9015 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1531
Practice Address - Country:US
Practice Address - Phone:718-241-1513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00803443Medicaid
NY0521971OtherAETNA
NY45100POtherHIP
NY253AR1OtherEMPIRE BCBS
NYP400951OtherOXFORD
NC153923-C24OtherHEALTH FIRST
NY5C4831OtherHEALTH NET
NY00803443Medicaid