Provider Demographics
NPI:1720146699
Name:EDANO, ALBERT EDANO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:EDANO
Last Name:EDANO
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 1:741 TURF RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3505
Mailing Address - Country:US
Mailing Address - Phone:516-792-0789
Mailing Address - Fax:516-792-0789
Practice Address - Street 1:1963 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5505
Practice Address - Country:US
Practice Address - Phone:718-241-1513
Practice Address - Fax:718-241-1513
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198162-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01591400Medicaid
NY01591400Medicaid
NY751511Medicare ID - Type Unspecified