Provider Demographics
NPI:1750793642
Name:SJ ALL MEDICAL PC
Entity type:Organization
Organization Name:SJ ALL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-790-7530
Mailing Address - Street 1:1311 BRIGHTWATER AVE APT 18IJ
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5962
Mailing Address - Country:US
Mailing Address - Phone:718-544-4200
Mailing Address - Fax:718-544-4201
Practice Address - Street 1:139 N CENTRAL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3856
Practice Address - Country:US
Practice Address - Phone:718-544-4200
Practice Address - Fax:718-544-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty