Provider Demographics
NPI:1669570487
Name:RIEGEL, EDWARD (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:RIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4309
Mailing Address - Country:US
Mailing Address - Phone:631-231-4455
Mailing Address - Fax:631-434-1728
Practice Address - Street 1:601 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4309
Practice Address - Country:US
Practice Address - Phone:631-231-4455
Practice Address - Fax:631-434-1728
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150491207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112355523OtherUNITED HEALTHCARE
NY41D812OtherB/C B/S
NYCS1009OtherOXFORD
NY000000079354OtherGHI PPO
NY00888399Medicaid
NY15049101OtherSUFFOLK HEALTH PLAN
NY150491SOtherHEALTHCARE PARTNERS
NY0051976OtherGHI PPO
NY4211247OtherAETNA PPO
NY5497240OtherCIGNA
NY00090924OtherAETNA HMO
NY27684POtherHIP
NYOC1414OtherHEALTHNET
NY112355523OtherUNITED HEALTHCARE
B14330Medicare UPIN